Objective: To explore the efficacy of methylprednisolone pulse therapy in the treatment of children with electrical status epilepticus during sleep (ESES) and the factors affecting the prognosis. Methods: Clinical and follow-up data from 32 children with ESES were collected. Based on different treatment methods during hospitalization

the subjects were divided into the anti-seizure medication (ASM) group and methylprednisolone + ASM group. In order to make clinical relief of ESES be considered as a positive event

Kaplan-Meier survival analysis was used to compare the one-year clinical relief of ESES in children treated with methylprednisolone pulse therapy in combination with ASM and those treated with ASM alone. Single-factor and multi-factor COX regression analysis were used to identify prognostic factors for children with ESES. Results: In the methylprednisolone + ASM group

the clinical relief rate of ESES was 58. 8% (10 / 17) at 6 months and 82. 3% (14 / 17) at 12 months

with a median relief time of 6 months (95% CI from 2. 975 to 9. 025). In the ASM group

the clinical relief rate of ESES was 20. 0% (3/ 15) at 6 months and 46. 7% (7/ 15) at 12 months

with a median relief time of > 12 months. Survival analysis showed that the median relief time for children in the methylprednisolone + ASM group was shorter than that for children in the ASM group

the difference was statistically significant

which was consistent with the Logrank test results (χ2 = 5. 473

P<0. 05). Moreover

children in the methylprednisolone + ASM group showed more significant cognitive improvement. Multi-factor COX regression analysis indicated that imaging findings ( normal vs. abnormal

HR= 7. 994)

family history ( negative vs. positive

HR = 5. 054)

and electroencephalogram discharge laterality ( unilateral vs. bilateral

HR= 2. 635) were independent risk factors affecting the prognosis of ESES. Conclusion: Methylprednisolone pulse therapy is effective in relieving electro-clinical seizures and improving cognitive function in children with ESES. Imaging abnormalities

positive family history and bilateral electroencephalogram discharges are independent risk factors affecting the prognosis of ESES.