Pulsatile Dexamethasone Therapy Reduces Epileptic Burden and Improves Sleep Physiology in Children with Genetic Drug-Resistant Epilepsy
Bibliographic record
Abstract
Background/Purpose: Corticosteroids and adrenocorticotrophic hormones (ACTH) are the therapy of choice to treat infantile spasms. However, systematic studies about the use in other types of childhood epilepsies remain rare, ACTH can have severe side effects, and studies using oral steroids vary widely in dosage and interval. This study compares the epileptic burden in children with genetic drug-resistant epilepsy before and after a standardized treatment with pulsatile corticoid therapy (PCT) using an objective (automated) and subjective approach ([ Fig. 1 ]). Methods: Twenty-four children (10 females, 6.2 3.4 years) with genetic drug-resistant epilepsy underwent a standardized protocol for PCT with cycles of 3 days of hospitalization and high-dose dexamethasone (20 mg/m 2 body surface). Recordings of electroencephalogram (EEG) during sleep and wake were obtained at baseline and at the end of PCT. We computed the epileptic burden (% of EEG burdened with spikes) before and after treatment. Secondary objectives were the sleep spindle rate, the seizure frequency, and subjective evaluation by the parents. Results: Spike burden was significantly lower in the EEG after PCT versus the baseline (5.4% [0.7–97.3] vs. 1.5% [0–96.9], p = 0.001, d = −0.41). Fig. 1 ( A ) Epileptic burden presented as percentage change is significantly reduced after PCT. ( B ) All spindle rates are borderline and fast sleep spindles significantly increased after PCT. Generalized epilepsy patients are represented by a square, focal epilepsy by a dot, DEE/PND by a triangle, and not classifiable patients by a diamond. Sleep physiology improved with significantly higher fast spindle rates in the EEG after PCT compared to the baseline EEG (0.8/min [0–2.2] vs. 1.5/min [0.2–3.4], p =0.015, d =0.36). Seizure frequency was improved in 17 patients (70.8%) and one patient became seizure-free. The highest improvement in everyday functioning was reported for quality of life (79.2%), cognition (70.8%), alertness (54.2%) and sleep (54.2%). No severe adverse effects were registered. Conclusion: Using objective and subjective markers, PCT in children with genetic drug-resistant epilepsy did not only lead to a reduction of epileptic burden but also to an improvement of physiological measurements important for cognitive functioning. Publication History Article published online: 13 November 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".