Epileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review)

Simple item page
dc.contributor.advisorWilmshurst, Jo
dc.contributor.authorRaga, Sharika Vinod
dc.date.accessioned2020-12-31T13:43:46Z
dc.date.available2020-12-31T13:43:46Z
dc.date.issued2020
dc.description.abstractImplementation of international guidelines for the treatment of epileptic spasms, is challenging when access to adrenocorticotrophic hormone (ACTH) and vigabatrin is restricted, especially in Low and Middle Income Countries (LMIC). Oral corticosteroids are alternative interventions but evidence for the optimal agent, dose, duration, efficacy and long-term effects are lacking. A systematic review of the literature was performed to assess the quality of evidence of prednisone and prednisolone (oral corticosteroids) for the management of epileptic spasms. There is level C recommendation based on class III evidence to support the efficacy of oral corticosteroids for the acute clinical control of epileptic spasms and EEG resolution. Efficacy of oral corticosteroids in comparison to the internationally recommended intervention of ACTH has class IV evidence supporting level U recommendation. Similarly, there is no data on the risk of relapse with oral corticosteroids (class IV, level U), compared to ACTH. There is class IV evidence supporting level U recommendation for the safety of oral corticosteroids and class II evidence for level B recommendation for ACTH. In terms of oral corticosteroids and effects on long-term development there is class IV evidence leading to level U recommendation, compared to class III evidence supporting level C recommendation for ACTH. Randomized controlled studies are needed to compare oral corticosteroids with ACTH, the optimal dosage and regimen as well as the long-term neurodevelopmental outcomes. Based on the limited existing studies a treatment guideline for LMIC is proposed which could be used to standardize interventions permitting clarification of these unmet questions.
dc.identifier.apacitationRaga, S. V. (2020). <i>Epileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review)</i>. (Master Thesis). University of Cape Town. Retrieved from http://hdl.handle.net/11427/32480en_ZA
dc.identifier.chicagocitationRaga, Sharika Vinod. <i>"Epileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review)."</i> Master Thesis., University of Cape Town, 2020. http://hdl.handle.net/11427/32480en_ZA
dc.identifier.citationRaga, S.V. 2020. Epileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review). Master Thesis. University of Cape Town. http://hdl.handle.net/11427/32480en_ZA
dc.identifier.ris TY - Master Thesis AU - Raga, Sharika Vinod AB - Implementation of international guidelines for the treatment of epileptic spasms, is challenging when access to adrenocorticotrophic hormone (ACTH) and vigabatrin is restricted, especially in Low and Middle Income Countries (LMIC). Oral corticosteroids are alternative interventions but evidence for the optimal agent, dose, duration, efficacy and long-term effects are lacking. A systematic review of the literature was performed to assess the quality of evidence of prednisone and prednisolone (oral corticosteroids) for the management of epileptic spasms. There is level C recommendation based on class III evidence to support the efficacy of oral corticosteroids for the acute clinical control of epileptic spasms and EEG resolution. Efficacy of oral corticosteroids in comparison to the internationally recommended intervention of ACTH has class IV evidence supporting level U recommendation. Similarly, there is no data on the risk of relapse with oral corticosteroids (class IV, level U), compared to ACTH. There is class IV evidence supporting level U recommendation for the safety of oral corticosteroids and class II evidence for level B recommendation for ACTH. In terms of oral corticosteroids and effects on long-term development there is class IV evidence leading to level U recommendation, compared to class III evidence supporting level C recommendation for ACTH. Randomized controlled studies are needed to compare oral corticosteroids with ACTH, the optimal dosage and regimen as well as the long-term neurodevelopmental outcomes. Based on the limited existing studies a treatment guideline for LMIC is proposed which could be used to standardize interventions permitting clarification of these unmet questions. DA - 2020 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PY - 2020 T1 - Epileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review) TI - Epileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review) UR - http://hdl.handle.net/11427/32480 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/32480
dc.identifier.vancouvercitationRaga SV. Epileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review). [Master Thesis]. University of Cape Town, 2020 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/32480en_ZA
dc.language.isoeng
dc.publisherUniversity of Cape Town
dc.publisher.departmentDepartment of Paediatrics and Child Health
dc.publisher.facultyFaculty of Health Sciences
dc.subject.otherPaediatric Neurology
dc.titleEpileptic Spasms: Evidence for oral corticosteroids and implications for low and middle income countries (Systematic Review)
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPhil
uct.type.publicationResearch
uct.type.resourceMaster Thesis
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
thesis_hsf_2020_raga_sharika_vinod.pdf
Size:
869.99 KB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Masters