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Table of Contents    
CORRESPONDENCE
Year : 2018  |  Volume : 66  |  Issue : 5  |  Page : 1524

Addition of pyridoxine to prednisolone in the treatment of infantile spasms: The knowledge gaps


Pediatrics Neurology Unit, Post Graduate Medical Education and Research, Chandigarh, India

Date of Web Publication17-Sep-2018

Correspondence Address:
Dr. Lokesh Saini
Pediatrics Neurology Unit, Post Graduate Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.241359

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How to cite this article:
Banerjee A, Saini L. Addition of pyridoxine to prednisolone in the treatment of infantile spasms: The knowledge gaps. Neurol India 2018;66:1524

How to cite this URL:
Banerjee A, Saini L. Addition of pyridoxine to prednisolone in the treatment of infantile spasms: The knowledge gaps. Neurol India [serial online] 2018 [cited 2018 Oct 23];66:1524. Available from: http://www.neurologyindia.com/text.asp?2018/66/5/1524/241359




Sir,

I read with interest the recent article entitled “Addition of pyridoxine to prednisolone in the treatment of infantile spasms: A pilot randomized controlled trial” published in Neurology India in March 2018.[1] I would like to congratulate the authors on their endeavour to explore a novel treatment by adding pyridoxine as an adjunct to the standard parenteral adrenocorticotrophic hormonal therapy in the treatment of West syndrome. This is an area of research where there is significant gap in knowledge among pediatricians and the subject also lacks quality evidence-base.[2],[3]

There are a few points that I would like to highlight in the study. The authors have mentioned having used high dose pyridoxine even though their methodology states that pyridoxine has been used in a dose of 30 mg/kg/day. The mentioned dose does not qualify as being a high dose, in its strict sense. The criterion for a high dose has been mentioned as 0.2-0.4 mg/kg/day in the Japanese literature.[4] In this regard, the paper of Pietze et al., from Germany has been erroneously cited, as the dose of pyridoxine used in the latter study was 300 mg/kg/day and not 300 mg/day as mentioned in the paper.[5] Besides, the authors have also used the criterion of ‘2 weeks after the starting of treatment' as the point of assessment of complete cessation. This, we feel, should be revised. This is because the West Delphi consensus clearly defines that complete cessation of infantile spasms should be ascertained at 2 weeks. Moreover, their cessation should be maintained for a period of 28 days from the last noted spasm. Hence, it would have been more pragmatic to use the 6-week post-treatment evaluation as the point of assessment of the primary outcome of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kunnanayaka V, Jain P, Sharma S, Seth A, Aneja S. Addition of pyridoxine to prednisolone in the treatment of infantile spasms: A pilot, randomized controlled trial. Neurol India 2018;66:385-90.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sahu JK. Infantile spasms--evidence based medical management. Indian J Pediatr. 2014;81:1052-5.  Back to cited text no. 2
    
3.
Vaddi VK, Sahu JK, Dhawan SR, Suthar R, Sankhyan N. Knowledge, attitude and practice (KAP) study of pediatricians on infantile spasms. Indian J Pediatr 2018. doi: 10.1007/s12098-018-2630-3.  Back to cited text no. 3
    
4.
Blennow G, Starck L. High dose B6 treatment in infantile spasms. Neuropediatrics 1986;17:7-10.  Back to cited text no. 4
    
5.
Pietz J, Benninger C, Schäfer H, Sontheimer D, Mittermaier G, Rating D. Treatment of infantile spasms with high-dosage vitamin B6. Epilepsia 1993;34:757-63.  Back to cited text no. 5
    




 

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