Objective Rett syndrome is a severe neurodevelopmental disorder most commonly associated with pathogenic variants of the MECP2 gene and frequently accompanied by epilepsy. Seizures occur in a substantial proportion of patients and may be resistant to conventional antiepileptic therapy. Emerging evidence suggests that neuroinflammatory processes may contribute to seizure propagation and represent a potential therapeutic target. Case Report A girl born at term with initially normal early development is described. At approximately 2 years of age, she developed regression of speech and stereotypic hand movements, accompanied by seizures and other neurological features consistent with Rett syndrome. The patient received long‐term therapy consisting of low‐dose prednisolone and methotrexate in addition to anticonvulsant treatment. During follow‐up, a reduction in seizure generalization and a shift in seizure pattern were observed, with generalized seizures becoming less frequent and replaced by brief focal seizures without secondary generalization. Conclusion In this single case, long‐term low‐dose prednisolone and methotrexate therapy was associated with a reduction in seizure generalization. Although a causal relationship cannot be established, this observation supports the hypothesis that immunomodulatory mechanisms may influence seizure propagation in pharmacoresistant epilepsy.
Naylya Djumaeva (Thu,) studied this question.