title: Use of ACTH and prednisolone in infantile spasms: experience from a developing country.
abstract: BACKGROUND
  Adrenocorticotrophic hormone (ACTH) and prednisone are both used to treat infantile spasms (IS) in West syndrome. In many countries, ACTH is expensive and difficult to obtain whereas, prednisone or prednisolone are cheap, given orally and easily available.
  
  
  OBJECTIVE
  The purpose of this retrospective data analysis was to compare the efficacy and cost of ACTH and prednisolone in the treatment of IS from the perspective of a developing country.
  
  
  METHODS
  Patients admitted with West syndrome in Children's Hospital, Islamabad, between January 1995 and December 2001 were included in the analysis. The diagnosis was made after eliciting a history of characteristic seizures and detecting hypsarrhythmia on the EEG. Parents were offered the use of either ACTH administered by intramuscular injection or prednisolone given orally. ACTH was expensive and difficult to obtain whereas prednisolone was cheap and easily available.
  
  
  RESULTS
  One hundred and five children were included in the study. Sixty-three were boys and their age ranged from 2 months to 3 years with a mean of 11 months. Thirty-three children received ACTH injections; 27 showed improvement and 11 remained spasms free after discontinuation of injections. Seventy-two patients were given oral prednisolone, 51 responded and 17 remained spasms free after oral steroids were stopped. Overall outcome was similar in both groups. The cost of ACTH injection was more than 100 times the cost of oral prednisolone.
  
  
  CONCLUSIONS
  No significant difference was seen in the final outcome in both treatment groups. Since prednisolone is inexpensive, easily available and given orally, it is the preferred mode of therapy.
authors.affiliation: Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. muneeb@sat.net.pk
authors.forename: Matloob
authors.initials: M
authors.lastname: Azam
authors.forename: Nasera
authors.initials: N
authors.lastname: Bhatti
authors.forename: Jai
authors.initials: J
authors.lastname: Krishin
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use*; D002675:Child, Preschool; D003906:Developing Countries; D004569:Electroencephalography; D005260:Female; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D006728:Hormones; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone