Abstracts

Rationale: As tertial referring center we see many patients with difficult to treat epilepsy and polypharmacoresistance. Because corticosteroids are a common and effective treatment in children with west-syndrome, we treated children with other epilepsy syndromes with Dexamethasone (DEXA). To avoid severe side effects, which often occur under continuous treatment for a longer time, we gave DEXA pulsatile - and oral for not harming the children.Methods: Before DEXA onset (as comedication) we performed a sleep eeg and analysed different blood parameters like glucose, blood count, liver enzymes, electrolytes, urine etc. as well we measured blood pressure, weight and height. Starting 2 days before first DEXA application the patients received Omeprazol (2 mg/kg BW max. 40 mg/d) for 8 days to prevent gastric ulcer. Daily dose of DEXA for 4 days was 1-1,2 mg/kg BW in patients smaller than 20 kg and 20 mg/square m BSA in those bigger than 20 kg. The whole dose was given in the morning. Blood pressure was controlled daily. All lab parameters as well as sleep eeg were controlled after the pulse. The pulses were repeated after 4 weeks. Depending on clinical efficacy and/or unwanted side effects we gave minimum 3 pulses, maximum 35 pulses over several years. Results: Overall 75 patients 47 male, 28 female (mean age 7,34 y; range: 5 mo 18.16 years) were treated. They have had without sufficient efficacy several AED (mean number: 5.86 range: 2 14) before. 25 patients (33.3 %) suffered from symptomatic focal epilepsies, 10 had CSWS, 7 had both. 10 patients had idiopathic generalised epilepsy, 4 had absences only. The other 19 patients had different syndromes e.g. Lennox-Gastaut-Syndrome, malignant migrating partial epilepsy. 17 patients became seizure free, 7 had good effects (seizure free first and than seizures again after variable time or seizure reduction ? 75 %). 32 patients had partial effects like seizure reduction ? 75 % or improvement of mood, behaviour, concentration or sometimes eeg. In 19 patients we didn t have any effect, including 2 who developed more seizures. Serious adverse events were reported in 4 patients (1 currant jelly stool, 1 higher blood pressure, 2 elevation of blood glucose). In 9 patients parents reported about a higher infection rate. Abrupt changes of mood were reported in 6 patients. 5 patients showed more appetite and 4 had weight gain after 3-6 months. Conclusions: Nearly 1/3 of all patients benefited well, 22,7 % became seizure free. Taking into account that only 4 patients had serious adverse events, which were reversible after stopping the therapy, one could conclude that pulsatile DEXA therapy is good approach to treat children and adolescents with different epilepsy syndromes who were classified as pharmacoresistant before.