title: Effectiveness of once-daily high-dose ACTH for infantile spasms.
abstract: There is insufficient evidence to recommend a specific protocol for treatment of infantile spasms (IS) and a lack of standardization among, and even within, institutions. Twice-daily dosing (for the first two weeks) of high-dose natural ACTH for IS is used by many centers and recommended by the National Infantile Spasms Consortium (NISC). Conversely, it is our practice to use once-daily dosing of high-dose natural ACTH for IS. In order to determine the effectiveness of our center's practice, we retrospectively reviewed 57 cases over the past four years at Boston Children's Hospital (BCH). We found that 70% of infants were spasm-free at 14days from ACTH initiation and 54% continued to be spasm-free at 3-month follow-up. Electroencephalogram showed resolution of hypsarrhythmia (when present on the pretreatment EEG) in all responders. Additionally, once-daily dosing of ACTH was well tolerated. We performed a meta-analysis to compare our results against the reports of published literature using twice-daily high-dose ACTH for treatment of IS. The meta-analysis revealed that our results were comparable to previously published outcomes using twice-daily ACTH administration for IS treatment. Our experience shows that once-daily dosing of ACTH is effective for treatment of IS. If larger prospective trials can confirm our findings, it would obviate the need for additional painful injections, simplify the schedule, and support a universal standardized protocol.
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: ryan.hodgeman@childrens.harvard.edu.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Hodgeman
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Kush
authors.initials: K
authors.lastname: Kapur
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Ann
authors.initials: A
authors.lastname: Paris
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Candice
authors.initials: C
authors.lastname: Marti
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Afra
authors.initials: A
authors.lastname: Can
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Amir
authors.initials: A
authors.lastname: Kimia
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Ann
authors.initials: A
authors.lastname: Bergin
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Annapurna
authors.initials: A
authors.lastname: Poduri
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Libenson
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lamb
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Saba
authors.initials: S
authors.lastname: Jafarpour
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Chellamani
authors.initials: C
authors.lastname: Harini
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000324:Adrenocorticotropic Hormone
keywords: ACTH; Epilepsy; Infantile spasms; Pediatrics; Seizures