Predictors of therapeutic response to monthly pulse IV methylprednisolone in pediatric epileptic encephalopathy: a cohort study

Abstract

Background: Pediatric epileptic encephalopathies (EE) are severe, drug-resistant epilepsy syndromes that often require adjunctive therapies beyond standard antiseizure medications. Data on predictors of response to intravenous methylprednisolone (IVMP), particularly in low- and middle-income countries, are limited.

Methods: This prospective cohort study at the Department of Paediatric Neurology and the Institute of paediatric neurodisorder and autism (IPNA) at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study period spanned January 2020 to June 2021, included 25 children with EE treated with monthly IVMP at a tertiary care center in Bangladesh. Clinical, electroclinical, and neuroimaging variables were analyzed to identify predictors of seizure response (≥50% reduction) using univariate and multivariate logistic regression.

Results: Sixteen children (64%) responded to IVMP. Responders were more likely to have CSWS (68.8% vs. 0%, p<0.001), normal neuroimaging (88.9% vs. 11.1%, p=0.005), and lower baseline seizure frequency (median 5 vs. 20 seizures/day, p=0.003), and none had cerebral palsy (p=0.003). Multivariate analysis confirmed CSWS (adjusted OR (aOR)=35.12, p=0.003), normal neuroimaging (aOR=18.21, p=0.022), and lower seizure burden (aOR=0.92, p=0.038) as independent predictors of response. Concomitant clobazam use showed an association in univariate analysis but did not remain significant after adjustment.

Conclusions: IVMP is a viable, cost-effective immunotherapy for selected children with EE, particularly those with CSWS, structurally normal neuroimaging, and lower seizure burden. Early recognition of these predictors can guide personalized treatment strategies and optimize outcomes in resource-limited settings.