Intravenous Methylprednisolone Versus Oral Prednisolone for Infantile Spasms (MPIV)

  • STATUS
    Recruiting
  • End date
    Oct 31, 2022
  • participants needed
    128
  • sponsor
    Suvasini Sharma
Updated on 18 February 2022
anticonvulsants
prednisolone
epilepsy
antiepileptic drugs
oral prednisolone
epileptic spasms
methylprednisolone oral
oral steroid therapy

Summary

Infantile Spasms (IS) are classically refractory to the usual antiepileptic drugs and often pose a therapeutic challenge. Since, there is associated significant morbidity, much effort has been directed over the past years to evaluate the role of various anticonvulsants in the management of IS. High dose oral prednisolone has been shown to cause early cessation of spasms and resolution of hypsarrythmia on Electroencephalogram. Recently, role of intravenous methylprednislone pulse therapy has been explored as one of the therapeutic modality in IS, in order to avoid the development of side-effects associated with prolonged oral steroid therapy and maintain long-term efficacy.However, there are no studies comparing iv methylprednisolone pulse therapy with high dose oral prednisolone..

Description

Multiple studies have subsequently used higher dose of prednisolone in infantile spasms at the weight based dosing of 4-8 mg/kg/day with a maximum dose of 60mg/day. The results have shown high rates of clinical and elecroencephalographic remission with lower relapse rates.However, a major concern related to corticosteroids, especially in infants and children, is the possible development of side effects. The most frequent ones are excessive weight gain, hyperphagia, water retention with edema, cushingoid appearance, hypertension, behavioral disturbances, increased infection susceptibility, leukopenia, electrolyte disturbances, hyperglycemia, glycosuria, impaired glucose tolerance, frank diabetes and sleep disorders. Furthermore, long-term side effects such as hypothalamus-pituitary axis suppression, psychosis, osteoporosis, nephrocalcinosis, brain atrophy, cataracts and, in children, growth retardation, have also been reported.

Recently, role of intravenous methylprednislone pulse therapy has been explored as one of the therapeutic modality in IS, in order to avoid the development of side-effects associated with prolonged oral steroid therapy and maintain long-term efficacy. There have been few studies on use of iv pulse methylprednisolone in IS with small sample size, showing to a rapid improvement in EEG & cessation of spasm in majority of the infants without significant adverse effects.

Emerging evidence suggests that intravenous pulse methylprednisolone might have superior efficacy and better safety profile when compared to high dose oral prednisolone in treatment of IS.

Hence, present study aims at comparing intravenous pulse methylprednisolone versus oral prednisolone in an open label, RCT for treatment of children with IS.

Details
Condition Infantile Spasm
Treatment Intravenous Methylprednisolone, Oral Pednisolone
Clinical Study IdentifierNCT03876444
SponsorSuvasini Sharma
Last Modified on18 February 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Newly diagnosed patients aged 4 - 30 months with epileptic spasms in clusters
with electroencephalographic evidence of hypsarrhythmia or its variants with
or without developmental delay -

Exclusion Criteria

Children with recognized progressive neurological illness will be excluded
Children with chronic renal, pulmonary, cardiac or hepatic dysfunction
Severe malnutrition (weight for length and height for less than 3 SD for mean as per WHO growth charts)
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