Outcome of High Dose Oral Prednisolone in Treatment of West Syndrome in Comparison to Low Dose ACTH

Introduction: West syndrome is a form of epileptic encephalopathy that typically manifests during infancy, often within the first year of life, and is characterized by developmental regression. Timely identification of its underlying cause and early therapeutic intervention are essential to minimizing the associated morbidity and mortality. The present study aimed to compare the effectiveness of high-dose oral prednisolone with that of intramuscular ACTH in managing West syndrome.Methods: This quasi-experimental study was carried out in the Department of Paediatric Neurology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, between September 2021 and August 2022. A total of 80 children diagnosed with West syndrome were enrolled and randomly assigned into two groups: Group A received intramuscular ACTH at a dose of 20 IU/day for two weeks, while Group B was administered oral prednisolone at 4–6 mg/kg/day for the same duration.Results: A statistically significant reduction in the mean seizure frequency was observed in both the ACTH and oral prednisolone groups following treatment (P < 0.001). Normal electroencephalographic findings were achieved in 52.5% of patients in the prednisolone group compared to 32.5% in the ACTH group. Perinatal asphyxia emerged as the predominant etiological factor in both groups (67.5% in the prednisolone group and 80% in the ACTH group). Irritability was the most commonly reported symptom, affecting 50% of the prednisolone group and 60% of the ACTH group.Conclusion: The findings indicate that both high-dose oral prednisolone and intramuscular ACTH are comparably effective in the treatment of West syndrome. No significant differences were found between the two groups in terms of spasm cessation, normalization of EEG patterns, or incidence of adverse effects.