title: [Clinical efficacy of shortened ACTH therapy --an individualized method for minimization of adverse effects--Part 1. The short-term outcome].
abstract: To minimize adverse effects and to get good efficacy of ACTH therapy against West syndrome, we tried a new 2-steps therapeutic protocol consisting of the shortened ACTH therapy and the additional ACTH therapy. In a prospective multi-institutional study, 20 patients with newly diagnosed West syndrome who had failed to respond to high-dose vitamin B6 and zonisamide were treated by this shortened ACTH therapy. Synthetic corticotropin (ACTH-Z 0.025 mg/kg/dose, max 0.25 mg) was administrated intramuscularly seven times on every other day for 14 days. At 1 month after discontinuing corticotropin, spasms and hypsarrhythmia disappeared in 10/20 (50%) and 13/17 (59%) patients respectively. Subsequently, 9 out of the 10 patients with persistent spasms received additional therapy for 1 or 2 weeks with daily intramuscular ACTH-Z, which was tapered off over a few weeks. Including the additional ACTH therapy, the disappearance of spasms and hypsarrhythmia were found in 13 patients (65%) and 13 patients (76%). Adverse effects during the shortened ACTH therapy were fewer than additional ACTH therapy but not statistically significant. Severe adverse effects were not observed in both ACTH therapy. In the 2-steps therapeutic protocol according to the response to ACTH, favorable results were obtained in seizure control, EEG findings and the degree of adverse effects.
authors.affiliation: Department of Pediatric Neurology, Bobath Memorial Hospital, Osaka. h_ueda@omichikai.or.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ueda
authors.forename: Katsumi
authors.initials: K
authors.lastname: Imai
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Toribe
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mano
authors.forename: Taro
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujikawa
authors.forename: Tetsuzo
authors.initials: T
authors.lastname: Tagawa
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Morita
authors.forename: Jiro
authors.initials: J
authors.lastname: Abe
authors.forename: Toshisaburo
authors.initials: T
authors.lastname: Nagai
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004569:Electroencephalography; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000324:Adrenocorticotropic Hormone