title: Randomized, Single-Blind, Parallel Clinical Trial on Efficacy of Oral Prednisolone Versus Intramuscular Corticotropin on Immediate and Continued Spasm Control in West Syndrome.
abstract: OBJECTIVE
  A single-center, single-blind, parallel-group, randomized clinical trial was performed to test the null hypothesis that adrenocorticotropic hormone is not superior to high-dose prednisolone for treatment of newly diagnosed West syndrome.
  
  
  METHODS
  Newly diagnosed infants with West syndrome were randomized to receive 14 days of oral prednisolone (40-60 mg/day) or a synthetically prepared intramuscular long-acting adrenocorticotropic hormone (40-60 IU/every other day [0.5-0.75 mg]) according to the United Kingdom Infantile Spasm Study protocol. They were blindly evaluated for infantile spasm remission by day 14, electroclinical remission (spasm cessation + resolution of hypsarrhythmia on a 30-minute electroencephalograph) by day 14 and continued spasm freedom for 28 days.
  
  
  RESULTS
  Ninety-seven patients were enrolled in the study, with 48 of them receiving prednisolone and 49 receiving ACTH. There was no significant difference in the baseline characteristics or risk factors for the two treatment groups. By day 14, cessation of infantile spasms occurred in 28/48 (58.3%) infants on prednisolone compared with only 18/49 (36.7%) infants given adrenocorticotropic hormone (P = 0.03) and electroclinical remission in 21 on prednisolone compared with nine on adrenocorticotropic hormone (P = 0.007). Sustained spasm control for 28 consecutive days following electroclinical remission occurred in 15 children on prednisolone compared with six on adrenocorticotropic hormone (P = 0.008). The total number of days required for spasm cessation was significantly less in those treated with prednisolone (3.85 days ± 2.4) compared with adrenocorticotropic hormone (8.65 days ± 3.7) (P = 0.001). Among patients who did not achieve remission, there was a non-significant trend toward greater quantitative reduction of spasms with prednisolone than with adrenocorticotropic hormone (P = 0.079).
  
  
  CONCLUSIONS
  Synthetic adrenocorticotropic hormone of 40-60 IU/every other day did not yield superior rates of electroencephalographic or clinical remission when compared with prednisolone of 40-60 mg/day. Significantly, more patients achieved electroclinical remission when treated with prednisolone than with adrenocorticotropic hormone.
authors.affiliation: Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. Electronic address: jithangi@gmail.com.
authors.forename: Jithangi
authors.initials: J
authors.lastname: Wanigasinghe
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Carukshi
authors.initials: C
authors.lastname: Arambepola
authors.affiliation: Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Shalini
authors.initials: S
authors.lastname: Sri Ranganathan
authors.affiliation: Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka.
authors.forename: Samanmalie
authors.initials: S
authors.lastname: Sumanasena
authors.affiliation: Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Gangani
authors.initials: G
authors.lastname: Attanapola
mesh_terms: D000284:Administration, Oral; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D012074:Remission Induction; D016037:Single-Blind Method; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone
keywords: ACTH; West syndrome; hypsarrhythmia; infantile spasms; prednisolone; treatment