Steroids in Pediatric Epilepsy: Infantile Spasms and Beyond..

Epilepsy is one of the most common neurological disorders in childhood, with multiple etiologies, acquired or congenital, symptomatic to previous central nervous system insults or resulting from genetic causes at the molecular level. The treatment of epilepsy has always aimed at eliminating or reducing the number of seizures, without necessarily influencing the pathophysiology of the disease itself. Several drugs with different mechanisms of action have been introduced over the last decades and used more or less successfully for seizure control. Among those, corticosteroids, known for their anti-inflammatory and anti-immune properties, have been used in different types of epilepsies and epileptic syndromes, which include West syndrome, Landau-Kleffner syndrome and electrical status epilepticus during sleep, Lennox-Gastaut syndrome, epilepsy with myoclonic-astatic seizures, as well as Rasmussen’s encephalitis. The use of steroids in the treatment of epilepsy beyond West syndrome has not been well defined, however, and is limited to a few studies. In this paper, we review the use of corticosteroids in the management of West syndrome and outline some of the proposed mechanisms of action of these drugs in this situation. We also discuss the use of steroids in the treatment of epilepsies other than those associated with infantile spasms.