title: Predictive factors for relapse of epileptic spasms after adrenocorticotropic hormone therapy in West syndrome.
abstract: OBJECTIVE
  To investigate whether serial electroencephalographic (EEG) findings can predict relapse of epileptic spasms after synthetic adrenocorticotropic hormone (ACTH) therapy in patients with West syndrome (WS).
  
  
  METHODS
  Thirty-nine WS patients (8 cryptogenic and 31 symptomatic) were included in this study. These patients received ACTH therapy for the first time and were regularly followed up for more than three years at our hospital. Sixteen patients (41.0%) showed seizure relapse (relapse group) and 23 patients (59.0%) did not show relapse (non-relapse group). We used survival analysis to investigate the influence of etiology and presence of epileptic discharges after the ACTH therapy on seizure outcome.
  
  
  RESULTS
  Immediately after the ACTH therapy, etiology was associated with seizure outcome (p=0.003). In the early stage (1 month after the ACTH therapy), only the presence of epileptic discharges (p=0.001) had a significant association with seizure outcome, regardless of etiology. Because all relapsed patients were in the symptomatic group, we performed the same statistical analysis on symptomatic WS patient data only. We found that the group with no epileptic discharges on EEG showed a significantly higher seizure-free rate than those with epileptic discharges in the early stage (p=0.0091).
  
  
  CONCLUSIONS
  This study demonstrated that serial EEG findings after ACTH therapy are significantly related to relapse of epileptic spasms.
authors.affiliation: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: gmd19010@s.okayama-u.ac.jp.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Child Neurology, Okayama University Hospital, Okayama, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Yoshinaga
authors.affiliation: Department of Child Neurology, Okayama University Hospital, Okayama, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: Department of Child Neurology, Okayama University Hospital, Okayama, Japan.
authors.forename: Fumika
authors.initials: F
authors.lastname: Endoh
authors.affiliation: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Ohtsuka
authors.affiliation: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Child Neurology, Okayama University Hospital, Okayama, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kobayashi
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D012008:Recurrence; D013036:Spasms, Infantile / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000324:Adrenocorticotropic Hormone
keywords: ACTH therapy; EEG; Epileptic discharges; Prediction of seizure relapse; Seizure outcome; West syndrome