title: Topiramate and adrenocorticotropic hormone (ACTH) as initial treatment for infantile spasms.
abstract: Historically, adrenocorticotropic hormone was used as a first-line treatment for infantile spasms; however, there has been increasing use of topiramate as initial therapy. Here, we report a retrospective study of adrenocorticotropic hormone (ACTH) and topiramate as initial treatment for infantile spasms. The neurology patient database at the Children's Hospital of Philadelphia was searched using the International Classification of Diseases, Ninth Revision code for infantile spasms, and 50 patients were randomly chosen for chart review. We identified 31 patients receiving either adrenocorticotropic hormone or topiramate monotherapy (adrenocorticotropic hormone n = 12, topiramate n = 19) as a first-line treatment for infantile spasms. A total of 26 patients were symptomatic and 5 cryptogenic. Six patients treated with adrenocorticotropic hormone had resolution of clinical spasms and hypsarrhythmia within a month, but 3 relapsed. Of the 19 patients treated with topiramate, 4 patients eventually, though over a period of 0, 1, 8, or 69 months, had resolution of spasms and hypsarrhythmia.
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Peltzer
authors.forename: William D
authors.initials: WD
authors.lastname: Alonso
authors.forename: Brenda E
authors.initials: BE
authors.lastname: Porter
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D017668:Age of Onset; D000855:Anorexia / Q000139:chemically induced; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006728:Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D053609:Lethargy / Q000139:chemically induced; D008297:Male; D012189:Retrospective Studies; D015983:Selection Bias; D013035:Spasm / Q000188:drug therapy / Q000503:physiopathology; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000503:physiopathology; D000077236:Topiramate; D016896:Treatment Outcome; D014202:Tremor
chemical_list: D000927:Anticonvulsants; D006728:Hormones; D000077236:Topiramate; D005632:Fructose; D000324:Adrenocorticotropic Hormone