title: A prospective study of dexamethasone therapy in refractory epileptic encephalopathy with continuous spike-and-wave during sleep.
abstract: OBJECTIVE
  Epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) is an intractable form of epilepsy that has no consensus protocol for corticosteroid therapy. This prospective study aimed to evaluate the efficacy and tolerability of dexamethasone for the treatment of CSWS.
  
  
  METHODS
  Patients (age: 4 years to 12 years and 5 months) with CSWS that failed to respond to several antiepileptic drugs and prednisolone at our pediatric neurology outpatient clinic between 2007 and 2015 were treated with dexamethasone and prospectively analyzed. An initial 4-week dexamethasone (0.15 mg/kg/day p.o.) scheme was employed, and response was assessed. If effective, dexamethasone was maintained for 2-3 months and then slowly weaned over several months, depending on individual patient response at each follow-up. Systemic evaluations (clinical evaluations, electroencephalography recordings, and analysis of side effects) were performed regularly thereafter.
  
  
  RESULTS
  Among 15 patients, 7 were defined as initial responders after 4-week dexamethasone treatment based on comprehensive clinical and electroencephalogram evaluations. The duration of dexamethasone treatment (including weaning) in these 7 patients was 6 to 10 months, and the follow-up duration was 6 months to 7 years. Three patients had no relapse after dexamethasone withdrawal at last follow-up. Among the other 4 patients, relapse was observed during dexamethasone withdrawal (n=1) or at 2-6 months after discontinuation of dexamethasone therapy (n=3). There were no serious or life-threatening side effects, and all observed side effects were reversible after discontinuation of dexamethasone.
  
  
  CONCLUSIONS
  Continuous oral dexamethasone treatment is an effective and tolerable therapy and should be an option for the treatment of CSWS.
authors.affiliation: Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Chen
authors.affiliation: Pediatric Research Institute, Chongqing Medical University, Chongqing, China. Electronic address: caifangc@126.com.
authors.forename: Fangcheng
authors.initials: F
authors.lastname: Cai
authors.affiliation: Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Chenggong
authors.initials: C
authors.lastname: Feng
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001927:Brain Diseases / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy* / Q000523:psychology; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007360:Intelligence; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
keywords: Children; Dexamethasone; Epileptic encephalopathy with continuous spike-and-wave during sleep