Corticosteroids including ACTH (adrenocorticotrophin hormone) for childhood epilepsy other than epileptic spasms

Background

We wanted to assess whether corticosteroids including ACTH are an effective treatment for children with epilepsy. Corticosteroids are sometimes used as an additional therapy to antiepileptic drugs in children with uncontrolled epilepsy. The role of corticosteroids in children with epilepsy is yet to be established.

Study characteristics

The evidence is current to August 2014. One study was included in this review. In total, data from five children, with uncontrolled seizures, aged between one and 11 years old were assessed. The duration of this study was two months; one month for the corticosteroid treatment and one month for the placebo (inactive) treatment. One of the five children was withdrawn from the study and another had epileptic spasms which meant we could not include their data in our analysis. Therefore, we were only able to compare data for three children. All three received both of the study treatments and the frequency of seizures they experienced while taking each treatment was compared.

Key results

One child showed a 25% to 50% reduction in seizure frequency whilst being treated with low dose corticosteroids compared to the placebo treatment. This child plus another child both showed a 25% to 50% reduction in seizure frequency whilst being treated with the higher dose of corticosteroids compared to the placebo treatment. A third child showed no reduction in seizures with either of the doses. As only one study was found which included data from three out of five participants, further statistical analysis was not possible. No conclusions can be drawn regarding the role of corticosteroids in children with epilepsy.

Quality of evidence

The evidence from the one study included in this review was rated as low quality due to the small sample size. There is a need for larger, well-designed studies.

Authors' conclusions: 

Since the last version of this review no new evidence has been found for the efficacy of corticosteroids in treating childhood epilepsies. Clinicians using steroids in childhood epilepsies, other than for epileptic spasms, should take this into account before using these agents.

Read the full abstract...
Background: 

This is an updated version of the original Cochrane review published in Issue 1, 2007.

Epilepsy is a disorder with recurrent epileptic seizures. Corticosteroids have been used in the treatment of children with epilepsy and have significant adverse effects. Their efficacy and tolerability have not been clearly established.

Objectives: 

To determine the efficacy, in terms of seizure control, improvements in cognition and in quality of life and tolerability of steroids compared to placebo or other antiepileptic drugs in children with epilepsy, excluding epileptic spasms.

Search strategy: 

We searched the following databases: The Cochrane Epilepsy Group Specialized Register (1 August 2014); CENTRAL, (The Cochrane Library Issue 7, July 2014); MEDLINE (1946 to 1 August 2014); EMBASE (1966 to December 2004); Database of Abstracts of Reviews of Effectiveness (DARE; Issue 3 of the database published in The Cochrane Library Issue 7, July 2014); ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform ICTRP (1 August 2014).

We checked the reference lists of retrieved studies for additional reports of relevant studies.

Selection criteria: 

All randomised controlled trials of administration of corticosteroids to children (less than 16 years) with epilepsy.

Data collection and analysis: 

For this update two review authors independently selected trials for inclusion and extracted data. Outcomes included cessation of seizures, reduction in seizure frequency, improvement in cognition, quality of life and adverse effects of steroids.

Main results: 

A single RCT was included that recruited five children in a double blind cross-over trial. One child was withdrawn prematurely from the study and another had infantile spasms and hence was excluded from further analysis. Adrenocorticotrophin hormone (ACTH 4-9) was administered. Of the three children analysed, one showed a reduction in seizures of 25% to 50% at both the low and higher doses of corticosteroids compared to placebo; one child showed a reduction in seizures at the higher dose only and one child showed no reduction in seizures at either dose. No adverse effects were reported.

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