ACTH activates rapid eye movement-related phasic inhibition during REM sleep in patients with infantile spasms.
OBJECTIVE
Phasic inhibition index (PII) is the rate of the simultaneous occurrence of phasic chin muscle activity (PCMA) and rapid eye movement bursts during rapid-eye-movement sleep (REMS). In naive patients with infantile spasms (IS), the PII value was found to reflect their prognosis. We studied the effects of adrenocorticotropic hormone (ACTH) on REMS components including PII in IS.


METHODS
REMS parameters were examined in 18 IS patients before and after ACTH treatment. The effects of corticosteroids (CSs) were examined in 3 patients with congenital adrenal hyperplasia (CAH) and 3 with nephrotic syndrome (NS).


RESULTS
ACTH decreased PII and PCMA in IS patients. In CAH patients, physiological doses of CSs corrected the increased intrinsic ACTH level and increased PII. In NS patients, therapeutic doses of CSs suppressed PCMA without affecting PII.


CONCLUSIONS
ACTH suppressed PCMA through CSs, and reduced PII directly. ACTH was hypothesized to eliminate IS through these dual modes of action.
Kohyama
J
J
Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, Japan.
Shimohira
M
M
Tanuma
N
N
Hasegawa
T
T
Iwakawa
Y
Y
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000494:pharmacology* / Q000627:therapeutic use*; D000311:Adrenal Glands / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000494:pharmacology* / Q000627:therapeutic use*; D002648:Child; D002680:Chin / Q000294:innervation; D004576:Electromyography / Q000379:methods; D005152:Facial Muscles / Q000294:innervation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000150:complications / Q000151:congenital / Q000473:pathology; D007223:Infant; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications; D009431:Neural Conduction / Q000187:drug effects; D009433:Neural Inhibition / Q000187:drug effects*; D017286:Polysomnography / Q000379:methods; D012895:Sleep, REM / Q000187:drug effects*; D013036:Spasms, Infantile / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000324:Adrenocorticotropic Hormone