Treatment of infantile spasms with very high dose prednisolone before high dose adrenocorticotropic hormone.
OBJECTIVE
This study investigated the short-term response to a standardized hormonal therapy protocol for treatment of infantile spasms.


METHODS
Twenty-seven children with video electroencephalography (EEG)-confirmed infantile spasms received very high dose (8 mg/kg/day, max 60 mg/day) oral prednisolone for 2 weeks. Response (absence of both hypsarrhythmia and spasms) to prednisolone was ascertained by repeat overnight video-EEG. Responders were tapered over 2 weeks and nonresponders were immediately transitioned to high dose (150 IU/m(2)/day) intramuscular adrenocorticotropic hormone (ACTH) for two additional weeks. Response was again determined by overnight video-EEG after ACTH therapy.


RESULTS
Sixty-three percent (17/27) of patients responded completely to prednisolone. Subsequently, 40% (4/10) of prednisolone nonresponders exhibited a complete response after an additional 2-week course with ACTH. Among 27 subjects with median follow-up of 13.5 months (interquartile range [IQR] 4.8-25.9), 12% (2/17) of prednisolone responders and 50% (2/4) of ACTH responders experienced a relapse between 2 and 9 months after initial response.


CONCLUSIONS
Very high dose prednisolone demonstrated significantly higher efficacy than previously reported for lower doses in prior studies. High dose ACTH may be superior to very high dose prednisolone, and in lieu of a definitive clinical trial, the choice between prednisolone and ACTH for initial treatment of infantile spasms remains controversial.
Division of Neurology, Department of Pediatrics, Mattel Children's Hospital and David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
Shaun A
SA
Hussain
Shlomo
S
Shinnar
Grace
G
Kwong
Jason T
JT
Lerner
Joyce H
JH
Matsumoto
Joyce Y
JY
Wu
W Donald
WD
Shields
Raman
R
Sankar
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D013036:Spasms, Infantile / Q000188:drug therapy*; D016896:Treatment Outcome
D000927:Anticonvulsants; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone
ACTHar; Corticosteroids; Corticotropin; Hypsarrhythmia; West syndrome