[Prednisolone therapy in refractory childhood epilepsy]

Steroids are effective medicaions for controlling the infantile spasms, but there have been few reports of steroid effect in other childhood epileptic syndromes, especially refractory syndromes. The objective of this study was to determine the efficacy of prednisolone in 35 children with intractable epilepsy. This prospective, uncontrolled study was undertaken at the Mofid paediatric Hospital from September 2004 to September 2005. Thirty five children [12 girls and 23 boys], aged bteween 1 to 12 years old with intractable epilepsy were enrolled. Prednisolone [1 mg/kg/day] was prescribed for 12 weeks [Once a day for 6 weeks follwed by every other day for another 6 weeks] in addition to their regular antiepileptic medications. The parents kept seizure diaries. After 1 year of follow up, 17 patients [49%] became seizure-free on prednisolone, whereas another 8 [23%] experienced a significant decreases more than 50% in seizure frequency. In contrast, ten patients [28%] had no changes in seizure frequency. The best response were seen in idiopathic epilepsy [95%] and atypical absence ones [86%]. The least therapeutic effect was seen in symptomatic myoclonic epilepsy [54%]. Side effects such as behavioral disturbances, weight gain and gastrointestinal bleeding were developed in 8 patients and also 14 patients were found to have cushingoid face. All the side effects were regressed after drug discontinuation Prednisolone therapy is a safe and effective adjunctive treatment for children with intractable epilepsy and it should be considered as an alternative treatment for older children with refractory epilepsy

[Comparing the effect of valproate and phenobarbital on weight gaining of epileptic children]

Respecting the high incidence of epilepsy among children and several reports coresponding the weight gaining of some during the valproate therapy, this study was conducted in "Mofid Children's Hospital" during 1384 to determine and compare the occurrence and severity of weigh gain among children treated with either valproate or phenobarbital. This clinical trails study was performed studying on 60 epileptic patients. We applied "International League against Epilepsy" classification to diagnose the patients. They were randomly equally divided into two groups [random allocation]. First group was treated with valproate 20 mg/kg/day, whereas second one received Phenobarbital 5 mg/kg/day [in divided dose]. Patients were followed for a six-month period. Body mass index [BMI] was measured at first, 2[nd], 4[th] and 6[th] months of therapy and BMI[6] was compared with expected BMI[6] [according to BMI curve] and the difference of latter two BMIs [BMI[6] and expected BMI[6]] were calculated. McNemar's test was used to compare the weight difference in each group and Chi-square test was applied for between-groups comparison. In valproate-treated patients whose their weights increased, some characteristics [including age, sex and primary weight] were evaluated by Fisher's exact test. Two groups were identical with respect to their age, sex, primary BMI and weight. 4 patients of phenobarbital group [13.3%] versus 20 patients of valproate group [66.7%], had weight gain [P=0.6 and P<0.0001, respectively]. Final-stage data revealed that compared to phenobarbital, valproate resulted in further weight gaining of children and adolescent [P<0.001]. Moreover, in valproate treated group, patients with older age and higher BMI, were more at risk of gaining weight. The risk of weight gainning in epileptic children treated with valproate is high. It seems that in patients above 10 years old and fat patients, this risk become more. We recommend further study to evaluate the effect of valproate on weight of epileptic patients older than 10 years and also fat patients