title: Cardiac vagal activation by adrenocorticotropic hormone treatment in infants with West syndrome.
abstract: West syndrome (WS) is a generalized epileptic syndrome of infancy and early childhood with various etiologies, and consists of a triad of infantile spasm, arrest or regress of psychomotor development and specific electroencephalogram (EEG) pattern of hypsarrhythmia. WS had been believed to be refractory, but recent evidence supports effectiveness of adrenocorticotropic hormone (ACTH) treatment. The ACTH treatment, however, has a problem that it is often accompanied by adverse autonomic symptoms. We therefore examined heart rate variability (HRV) for assessing cardiac autonomic functions in WS and prospectively observed the changes during ACTH treatment. We studied 15 patients with WS and 9 age-matched controls during sleep (EEG stage 2). Compared with controls, the patients with WS were greater in the low-frequency component (LF) of HRV, an index reflecting sympatho-vagal interaction (p = 0.02), but were comparable for high-frequency component (HF) and LF-to-HF ratio (LF/HF), indices reflecting cardiac vagal activity and sympathetic predominance, respectively. During ACTH treatment, heart rate decreased (p < 0.01), LF and HF increased (p < 0.01), and LF/HF did not differ significantly. These results indicate that WS might be accompanied by autonomic changes and that ACTH treatment enhances parasympathetic function and causes bradycardia.
authors.affiliation: Department of Pediatrics, Neonatology and Congenital Disorders, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. aykhat@med.nagoya-cu.ac.jp
authors.forename: Ayako
authors.initials: A
authors.lastname: Hattori
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hayano
authors.forename: Shinji
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Ando
authors.forename: Kumiko
authors.initials: K
authors.lastname: Mizuno
authors.forename: Michi
authors.initials: M
authors.lastname: Kamei
authors.forename: Satoru
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Togari
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D001341:Autonomic Nervous System / Q000187:drug effects*; D001919:Bradycardia / Q000139:chemically induced*; D004562:Electrocardiography; D004569:Electroencephalography; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D013036:Spasms, Infantile / Q000188:drug therapy*; D018709:Statistics, Nonparametric
chemical_list: D000324:Adrenocorticotropic Hormone