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The etiology and response to high dose oral prednisone in children with infantile spasms - a resource-poor country perspective
Thesis (MMed)--Stellenbosch University, 2019.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2019
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| _version_ | 1867613987589324800 |
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| access_status_str | Open Access |
| author | Marais, Sumari |
| author2 | Van Toorn, Ronald |
| author_browse | Marais, Sumari Van Toorn, Ronald |
| author_facet | Van Toorn, Ronald Marais, Sumari |
| author_sort | Marais, Sumari |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (MMed)--Stellenbosch University, 2019. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/106958 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:44:52.743Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2019 |
| publishDateRange | 2019 |
| publishDateSort | 2019 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/106958 The etiology and response to high dose oral prednisone in children with infantile spasms - a resource-poor country perspective Marais, Sumari Van Toorn, Ronald Solomons, Regan Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health. Etiology Prednisone -- Dosage Epilepsy in children Infantile spasms Poor -- Medical care Thesis (MMed)--Stellenbosch University, 2019. Background and objective: Hormonal therapy is the treatment of choice in most infants with infantile spasms (IS). Intramuscular adrenocorticotropic hormone (ACTH) has historically been the treatment of choice, however, its usage is complicated by unavailability and financial constraints, even more so in resource limited settings. Our institution has used high dose prednisone as the first-line hormonal treatment of infantile spasms since 2006. In this study we investigated the efficacy and safety of high dose oral prednisone. In addition, we describe the most common causes of IS in our setting. Methods: Medical records of infants who presented to Tygerberg Hospital with IS and who were treated with high-dose oral prednisone (4mg/kg/day), from September 2012 through August 2016, were reviewed. Electro-clinical response was defined as clinical spasm-freedom and resolution of hypsarrythmia within two weeks of initiation of therapy. Results: Over the 4-year period, 50 children with new-onset IS were treated. The mean duration of epileptic spasms prior to initiation of treatment was 15.4 days (range 7.64-23.176 days) and the mean age of diagnosis was 22.83 weeks (range 19.19-26.47 weeks). The majority of infants (78%) exhibited developmental delay prior to the onset of spasms. Hypoxic ischemic encephalopathy and white matter injury of prematurity, were the most common etiologies. Electro-clinical response occurred in 32 (64%) of infants within two weeks of the onset of treatment. No major side effects were encountered during the treatment period. Conclusion: Our results continue to demonstrate that high dose oral prednisone is very effective for the treatment of new-onset infantile spasms, with no major adverse effects. Oral prednisone represents a less expensive, readily available alternative to ACTH injections, especially in resource-constrained settings. A significant proportion of IS cases can be attributed to potentially preventable etiologies such as hypoxic ischemic encephalopathy, white matter injury of prematurity and hypoglycemic encephalopathy. Agtergrond: Hormonale terapie is die behandeling van keuse vir die meeste kinders met infantiele spasmas (IS). Intramuskulêre adrenokortikotrofiese hormoon (AKTH) is histories die behandeling van keuse, maar die gebruik daarvan word gekompliseer deur ontoereikenheid and finsiële beperkings veral in beperkte hulpbronne instansies. Hoë dosis prednisoon word as eerste linie hormonale terapie vir IS by Tygerberg Hospitaal gebruik. In hierdie studie word die effektiwiteit en veiligheid van hoë dosis prednisoon ondersoek. Verder, word ook die mees algemene oorsake van IS, by ons instansie, beskryf. Metodes: Die mediese rekords van kinders wat by Tygerberg Hospitaal presenteer het met IS en met hoë dosis orale prednisoon (4mg/kg/dag), vanaf September 2012 tot en met Augustus 2016 behandel is, was na gegaan. Elektro-kliniese respons was gedefinieer as klinies spasma vryheid en resolusie van hipsaritmië binne twee weke vanaf die begin van behandeling. Resultate: ‘n Totaal van 50 kinders, oor ‘n 4 jaar periode, was met nuwe aankoms IS by Tygerberg Hospitaal behandel. Die gemiddelde duur van spasmas voor die begin van behandeling was 15.4 dae (omvang 7.64-23.176 dae) en die gemiddelde ouderdom met diagnose was 22.83 weke (omvang 19.19-26.47 weke). Die meerderheid van kinders (78%) het ontwikkelingsagterstand getoon voor die begin van spasmas. Hipoksiese isgemiese enkefelopatie en witstof besering van premaruteit was die mees algemeenste oorsake. Elektro-kliniese respons was behaal in 32 (64%) van kinders binne twee weke van die aanvang van behandeling. Geen nadelige effekte was aangemeld tydens die behandelingsperiode. Gevolgtrekking: Die resultate demonstreer dat hoë dosis prednisoon ‘n baie effektiewe behandeling vir nuwe aankoms IS is, met geen noemenswaardige nadelige effekte nie. Orale prednisoon is ‘n meer bekostigbare, maklik verkrygbare alternatief tot AKTH intramuskulêre inspuitings, veral by ‘n beperkte-hulpbron instelling. ‘n Groot hoeveelheid van IS gevalle het potensieël ‘n voorkombare etiologie, soos hipoksiese isgemiese enkefelopatie, witstof besering van premaruteit and hipoglusemiese enkefelopatie. Masters 2019-11-26T09:48:03Z 2019-12-11T06:40:24Z 2021-02-01T03:00:13Z 2019-12 Thesis http://hdl.handle.net/10019.1/106958 en_ZA Stellenbosch University 29 pages application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Etiology Prednisone -- Dosage Epilepsy in children Infantile spasms Poor -- Medical care Marais, Sumari The etiology and response to high dose oral prednisone in children with infantile spasms - a resource-poor country perspective |
| title | The etiology and response to high dose oral prednisone in children with infantile spasms - a resource-poor country perspective |
| title_full | The etiology and response to high dose oral prednisone in children with infantile spasms - a resource-poor country perspective |
| title_fullStr | The etiology and response to high dose oral prednisone in children with infantile spasms - a resource-poor country perspective |
| title_full_unstemmed | The etiology and response to high dose oral prednisone in children with infantile spasms - a resource-poor country perspective |
| title_short | The etiology and response to high dose oral prednisone in children with infantile spasms - a resource-poor country perspective |
| title_sort | etiology and response to high dose oral prednisone in children with infantile spasms a resource poor country perspective |
| topic | Etiology Prednisone -- Dosage Epilepsy in children Infantile spasms Poor -- Medical care |
| url | http://hdl.handle.net/10019.1/106958 |
| work_keys_str_mv | AT maraissumari theetiologyandresponsetohighdoseoralprednisoneinchildrenwithinfantilespasmsaresourcepoorcountryperspective AT maraissumari etiologyandresponsetohighdoseoralprednisoneinchildrenwithinfantilespasmsaresourcepoorcountryperspective |