Convulsive Seizures, Intractable Epilepsy
Conditions
Brief summary
Although corticosteroids have been shown to be beneficial anecdotally for refractory epilepsy, the effects of corticosteroids on pediatric epilepsy have primarily been studied retrospectively amongst a heterogeneous patient population. The objective of this prospective cross-over study is to determine the effect of oral steroids on convulsive seizure frequency and evaluate the tolerability of pulsed oral steroids. Participants will be prospectively enrolled from pediatric neurology clinic at Children's Hospital of New Orleans, and baseline seizure frequency will be assessed. Participants will then be randomized to receive either the study drug, methylprednisolone, or placebo during the first month, followed by a one-month wash-out period. During the third month of the study, participants will enter the cross-over phase of the study where those who received methylprednisolone will receive placebo, and those who received placebo will receive methylprednisolone. The primary outcome will be the percentage of patients with 50% or more reduction in seizure frequency following one course of oral methylprednisolone. frequency following 1 course of oral methylprednisolone.
Interventions
DRUGmethylprednisolone sodium succinate
Methylprednisolone sodium succinate will be re-constituted in simple syrup in a concentration of 80mg/mL and will be administered orally at 20mg/kg (max 1000mg) for days 1, 2, and 3 of the intervention phase of the study.
OTHERPlacebo
The placebo used in this study will be simple syrup.
Sponsors
Louisiana State University Health Sciences Center in New Orleans
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
2 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
1. Patients age 2 -18 years of age 2. Patients who have at least 4 convulsive (generalized tonic or tonic-clonic) seizures per month on 2 or more anti-epileptic drugs (AEDs) at therapeutic doses a. Epilepsy diagnosed by historical clinical evidence 3. Family's ability to understand and willingness to sign a written informed consent document for patients under 18. 4. Willingness to complete seizure diary for duration of study 5. Willingness to present to all study visits
Exclusion criteria
1. Patients with history of the following diagnoses: 1. Traumatic brain injury 2. Tuberous sclerosis 3. Sturge Weber 4. Cortical dysplasia 2. Patients with known hereditary degenerative diseases as follows: 1. Adrenoleukodystrophy 2. Neuronal ceroid lipofuscinosis 3. Leigh Syndrome 4. Myoclonic epilepsy with ragged red fibers (MERRF) 5. Rett Syndrome 3. Patients with the following epilepsy syndromes 1. Infantile spasms 2. West Syndrome 3. Progressive myoclonic epilepsy 4. Dravet syndrome 5. Doose syndrome 6. Ohtahara syndrome 7. Rasmussen's encephalitis 4. Patients with the following metabolic disorders 1. Phenylketonuria 2. Maple syrup urine disease 3. Organic acidemias 4. Galactosemia 5. Peroxismal disorders (e.g. Zellwegers) 6. Lysosomal disorders 7. Urea cycle disorders 5. Patients with history of immunodeficiency 6. Patients with the following infections 1. HIV/AIDS 2. Active or latent TB 3. Active or suspected bacterial infection 4. Active, latent or suspected fungemia 5. Active or suspected parasitic infection 7. Patients with history of malignancy 8. Patients with history of or active myopathy 9. Patients with degenerative neuromuscular disorders 10. Patients with history of hypersensitivity or allergic reactions to corticosteroids 11. Patients with history of psychosis 12. Patients with diabetes mellitus 13. Pregnancy 14. Any underlying predisposition to gastrointestinal bleeding (peptic ulcer disease, gastritis, colitis)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Seizure frequency | The number of seizures per month will be assessed at 1 month (following placebo/intervention), 2 months (following wash-out), and 3 months (following cross-over phase of placebo/intervention). Change compared to baseline will be calculated. | The percentage of patients with 50% or more reduction in seizure frequency. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Seizure freedom | The number of seizures per month will be assessed at 1 month (following placebo/intervention), 2 months (following wash-out period), and 3 months (following cross-over phase of placebo/intervention). | The percentage of participants who become seizure free over 1 month |
| Adverse events | Adverse events will be recorded at 1 month (following placebo/intervention), 2 months (following wash-out period), and 3 months (following cross-over phase of placebo/intervention). | Percentage of participants who reports adverse events and the severity of the adverse events. |
| Drop out percentage | The number of participants who drop out will be counted and recorded at 1 month (following placebo/intervention), 2 months (following wash-out period), and 3 months (following cross-over phase of placebo/intervention). | Percentage of participants who drop out of the study due to adverse events |
Countries
United States
Contacts
Primary ContactXinran Maria Xiang, MD
Outcome results
None listed