Introduction: West syndrome (WS) is a catastrophic epileptic encephalopathy. Treatment in resource-limited settings could be quite challenging due to the high cost and limited availability of adrenocorticotropic hormone.

Aim: To determine seizure remission rates and adverse drug reactions (ADRs) to high-dose prednisolone in a cohort of Nigerian children with WS.

Methods: Infants diagnosed with WS over a period of 20 months were admitted and placed on 40mg daily dose of prednisolone, with an increase to 60mg if indicated. Diagnosis was based on clinical history, caregivers’ video recordings of events and hypsarrhythmias on electroencephalography (EEG). All were prospectively followed with daily weighing, daily urinalysis, 6hourly blood pressure (BP) monitoring, daily blood sugar and seizure diary till discharge and the clinic post-discharge. Outcome variables of interest were seizure remission, normalisation of EEG and ADRs to prednisolone.

Results: 22 children were enrolled- 14 males and 8 females. Mean age at seizure onset and diagnosis were 4.84(2.0) and 11.9(5.4) months respectively. The leading causes of WS were severe perinatal asphyxia (45.5%) and congenital brain malformation (22.7%). Seventeen (72.3%) attained total seizure freedom and 20 (90.9%) had significant reduction in seizure frequency. Eight (47.0%) of the 17 children with complete seizure freedom required an increase in dose of prednisolone to attain remission. Longest seizure-free period at time of discharge ranged from 6 to 17 days.

Conclusion: High-dose prednisolone represents a cheap and cost-effective treatment for WS in resource-limited settings. It is relatively well tolerated, with high rate of seizure remission accompanied by resolution of hypsarrhythmias.

Ikeoluwa Lagunju
University College Hospital
Nigeria

Oreoluwa Lagunju
University College Hospital
Nigeria

Joy Alejo
University College Hospital
Nigeria

Oluwatobi Robert
University College Hospital
Nigeria

Michael Adeyekun
University College Hospital
Nigeria

Amarachi Bayo
University College Hospital
Nigeria