Introduction: - To assess efficacy of very high dose prednisolone in patients with West syndrome.

Methodology: -This was an observational study conducted at a tertiary level hospital from August 2015 to August 2016. Ethical clearance for study was obtained from institutional ethical committee. Children aged 2-23 months, presenting with clinical spasms and EEG evidence of hypsarrhythmia were included in the study. Children with systemic illness or severe acute malnutrition were excluded from the study. Study participants were started on very high dose prednisolone (8 mg/kg/day, maximum 60mg/day). The primary outcome measure was complete cessation of spasms and clearance of hypsarrhythmia on EEG after 2 weeks of prednisolone treatment.

Results: - Forty children were started on very high dose prednisolone of whom four did not come for the 2 week follow up and were excluded. Response rate in the remaining  patients was 55.6% (20/36) after 2 weeks of steroid therapy. Sixteen patients who did not respond to prednisolone were advised ACTH. Of the 7 who consented for ACTH (7/16) only one (14.3%) responded. The 15 non-responders to prednisolone and ACTH were started on Vigabatrin. Side effects seen during hormone therapy included increased appetite in 29 (80.6%) patients, irritability in 27 (75.0%) patients and weight gain in 26 (72.2%) patients.

Conclusion: - Our 55.6% response rate is supportive better outcome with high dose prednisolone. It is consistent with 63% & 51.6% response rate from previous studies^1,2 and the 31% pooled response^3,4 to traditional dose (2mg/kg/day) prednisolone.