[Efficacy of repeated adrenocorticotropic hormone therapy in patients with intractable epileptic spasms].
OBJECTIVE
We examined the effectiveness of repeated adrenocorticotropic hormone (ACTH) therapy in short-term and long-term seizure control in patients with intractable epileptic spasms.


METHODS
Twenty-five patients with intractable spasms, in whom epileptic seizures were not controlled or relapsed after the first ACTH therapy, were given repeated ACTH therapy. The short-term effect (seizure control longer than two months) of repeated ACTH therapy was analyzed, and the long-term effect was estimated by Kaplan-Meier method.


RESULTS
Short-term seizure control by repeated ACTH therapy was achieved in 13 of 25 patients (52.0%), and in 5 of 13 patients, seizures were controlled by ACTH therapy at higher doses compared with the first ACTH therapy. Short-term effectiveness was obtained in 76.5% of patients who had epileptic spasms alone at the time of the second ACTH therapy, but was ineffective in all 8 patients who had multiple types of seizures, with relapses within 2 months. Short-term effectiveness was not associated with clinical factors such as onset age, age of repeated ACTH treatment, and EEG findings. Regarding the long-term effect of repeated ACTH therapy, the period until seizure relapse was significantly longer in patients with epileptic spasms alone compared to patients with multiple seizure types. Spasms were controlled in 5 of 25 cases (20.0%) at the final observation. In patients with multiple seizure types and patients with onset age older than eight months, seizure control was not obtained. Long-term outcome was good in patients with treatment lag within 2 months.


CONCLUSIONS
In repeated ACTH therapy, seizure type seems to be one of the major determinants for short- and long-term seizure outcome.
Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, Shizuoka. ikegami@is.icc.u-tokai.ac.jp
Mariko
M
Ikegami
Yukitoshi
Y
Takahashi
Hiroko
H
Ikeda
Katsumi
K
Imai
Hideyuki
H
Otani
Yuko
Y
Kubota
Hideo
H
Shigematsu
Rumiko
R
Takayama
Yukiko
Y
Mogami
D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D017668:Age of Onset; D002675:Child, Preschool; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D013036:Spasms, Infantile / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone