Intravenous methylprednisolone pulse therapy in a young girl with intractable absence seizures.

clusters of absence seizures. The patient was born after an uncomplicated pregnancy by spontaneous delivery and an uneventful perinatal period. Growth and development were normal and she was in second grade in a regular school. Her medical history included right nephrec-tomy because of a dysplastic kidney. Since she was 5 years old her parents noted multiple daily episodes of staring, sometimes associated with rhythmic movements of the eyelids lasting 10–15 seconds. An electroencepalograph study revealed the typical pattern of generalized three per second spike and wave complexes. Therapeutic trials with ethosuximide 20 mg/kg/day, valproic acid 50 mg/kg/day, lamotrigine 5 mg/ kg/day and topiramate 5 mg/kg/day failed to control the seizures. On admission, the physical and neuro-logic examinations were within normal limits. Treatment with levetiracetam 50 mg/kg/day was begun and a subsequent video-EEG study recorded numerous clinical and electrical epileptic episodes of absence seizures. At that point, an attempt was made to introduce the ketogenic diet. However, the diet was stopped after a week due to poor compliance of the patient and the family. Subsequently, a 5 day course of IV methylprednisolone 30 mg/kg/day was started, with normal vital signs and blood electrolyte values throughout treatment. A dramatic clinical improvement was observed 2 days after the last dose. The video-EEG study revealed a EEG = electroencepalograph For editorial see page 176 t he medical treatment of epilepsy is effective in the majority of patients, resulting in seizure control and a normal lifestyle. However, about 25% of patients are refractory to treatment with anti-epileptic drugs. In these patients, other therapeutic measures are considered, such as epilepsy surgery, vagal nerve stimulation, ketogenic diet, and drugs rarely used in epilepsy such as steroids and immuno-globulins. Steroids and adrenocortical hormones have been used, particularly in infantile spasms (West syndrome). In addition, there are a few reports on the use of oral steroids in children with other forms of intractable epilepsy, including absence seizures [1,2]. But there are no reports on the use of intravenous steroid pulse therapy in children with refractory absence epilepsy. We present a young girl with absence seizures resistant to all syndrome-appropriate anti-epileptic drugs, who showed a dramatic clinical and electrophysi-ological improvement after IV pulse therapy with methylprednisolone. Patient descriPtiOn A 7 year old girl with absence seizures was admitted to the pediatric neurology department because of multiple daily significant decrease in the amount of epileptiform activity, now noted mostly during sleep. …