Comparison of Oral Prednisolone and ACTH Therapies in Infantile Epileptic Spasms Syndrome: Using BASED and E-Chess Scores

OBJECTIVE:This study aimed to compare the efficacy of adrenocorticotropic hormone (ACTH) and oral prednisolone therapies in children with infantile epileptic spasms syndrome (IESS), utilizing the Burden of Amplitudes and Epileptiform Discharges (BASED) score to assess electrographic severity and the Early Childhood Epilepsy Severity Scale (E-Chess) to evaluate clinical outcomes. METHODS:This retrospective cross-sectional study included 40 children aged 1 to 16 months with IESS. Children received either ACTH (n = 23) or high-dose oral prednisolone (n = 17). Electroencephalographic severity was assessed before treatment and on day 28 post-treatment using the BASED score. Clinical epilepsy severity was evaluated at one year post-treatment using the E-Chess score. RESULTS:Both treatment groups showed significant reductions in BASED scores (overall cohort p < 0.001; ACTH group p < 0.001; prednisolone group p = 0.007). However, there was no statistically significant difference between the ACTH and prednisolone groups regarding post-treatment BASED or E-Chess scores. While clinical factors such as gender, age, and etiology were not associated with favorable outcomes, a lower post-treatment BASED score was significantly associated with a better clinical prognosis (p = 0.007). Notably, a higher number of pretreatment anti-seizure medications (ASMs) was a strong predictor of poor clinical outcome (OR: 5.474, 95% CI: 1.849-16.207; p = 0.002). CONCLUSION:High-dose oral prednisolone and ACTH therapies demonstrated comparable efficacy in reducing electrographic and clinical seizure burden in children with IESS. Improvement in epileptiform activity, as reflected by reductions in the BASED score, is strongly associated with better clinical outcomes. Additionally, a high pretreatment medication burden may serve as an early indicator of a refractory clinical course.