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We read with interest, the recent article by Gonzalez-Giraldo and colleagues.[1] These authors retrospectively studied the effect of high-dose oral steroids in children with epileptic spasms. In the study, all the children were treated initially with 40 to 45 mg/day of steroids and the dose was escalated to 60 mg/day if there was persistent spasm after one week of therapy. If we convert the steroid dose (40 to 45 mg/day) that was given in the study to per kilogram of body weight, then it would be around 3 to 13 mg/kg/day, which would be a very high dose for younger children and can lead to adverse effects of steroid toxicity. [Extracted from the article]

Highlights from the article: The primary objective of the study was to identify various risk factors for pathologic macrocephaly, and the authors identified 267 children with macrocephaly. Numerous disorders have been associated with macrocephaly in children, including hydrocephalus, metabolic and anatomic megalencephaly, subdural fluid collection, autistic disorders, genetic and neurocutaneous syndromes, and familial macrocephaly. Macrocephaly in rickets is usually due to parietal and frontal bossing, and neuroimaging classically shows benign enlargement of subarachnoid space.