Ho-ho-ho! Gather around, my little elves, for a tale not of toys and reindeer, but of a quest as important as delivering presents on Christmas Eve. This story unfolds in the world of medicine, where researchers embarked on a systematic sleigh ride through the snowy fields of data to uncover the secrets of adrenocorticotropic hormone (ACTH) and corticosteroids in treating children with certain types of stubborn epilepsies, not including the infamous infantile epileptic spasm syndrome (IESS).

Our diligent elves, I mean researchers, checked their list not once but twice, ensuring they included studies that were both naughty and nice—retrospective and prospective, but only those reporting on more than five patients with clear definitions and outcomes. They searched through the vast libraries of multiple databases and registries, assessing the risk of bias with a keen eye, much like how I scrutinize the quality of cookies left out on Christmas night.

With a sprinkle of magic, they pooled together data from 38 studies, involving 1152 patients, much like how I manage to fit countless toys into my sack. Their findings were wrapped up neatly, showing that these treatments could indeed bring joy to many, with a pooled proportion of 0.60 for seizure response and 0.56 for the reduction of those naughty EEG spikes by the end of treatment. Yet, like the occasional toy that breaks too soon, the relapse rate was high, at 0.33.

Through the lens of their magical snow globe, they observed a small benefit of ACTH and found that all other corticosteroids were equally jolly. Certain conditions, like electric status epilepticus in slow sleep (ESES), received a bit more holiday cheer, while those with cognitive impairments and “symptomatic” etiology found fewer presents under their tree.

However, not all was merry and bright. Obesity and Cushing’s syndrome, much like coal in a stocking, were common adverse effects, especially in trials with continuous administration of these treatments. Yet, hope glimmered for those receiving intermittent doses, showing far fewer side effects.

But, my dear friends, as with all tales, this one comes with a caution: the high risk of bias and large heterogeneity among the studies are like patches of ice on a rooftop, making our conclusions a bit slippery. This grand adventure was registered under the International Prospective Register of Systematic Reviews (PROSPERO) number CRD42022313846, and embarked upon without a single penny of financial support, much like my own annual journey around the globe.

So, as we tuck into our beds on Christmas Eve, let’s remember the efforts of those seeking to bring health and happiness to all, through the gift of knowledge. Merry Christmas to all, and to all a good night!