When the first-line immune-modulating course does not produce sufficient clinical or EEG improvement in a patient with continuous spike-and-wave during sleep (CSWS), a defined next-line treatment strategy provides the structured path forward.
The previous management used steroids or immune-modulating agents — including oral prednisone or prednisolone, intravenous pulse-dose methylprednisolone, ACTH, or IVIG. That approach did not reach the following required targets:
This protocol defines the next step once those goals remain unmet.
The protocol involves specific anti-seizure medications (ASMs) — a class of agents that are most commonly prescribed in this clinical setting. The full selection criteria, medication choices, sequencing, and monitoring schedule are contained in the structured regimen.
Of ASMs, valproic acid, ethosuximide, and levetiracetam are most commonly prescribed, but reports on a variety of ASMs and other agents also exist.
The clinical response was defined as clinical improvement in neurocognitive function, seizures, or the EEG after therapy as judged and documented in the medical record by the treating neurologist.
The SWI response was defined by a 50% reduction in the sleep SWI when comparing the post- and pre-treatment EEGs.
DOI: 10.1016/j.jpeds.2021.01.032 View source ↗