Double-blind study of ACTH vs prednisone therapy in infantile spasms*

https://doi.org/10.1016/S0022-3476(83)80606-4Get rights and content

Twenty-four patients with infantile spasms were entered in a double-blind, placebo-controlled, crossover study to compare the therapeutic effectiveness of ACTH (20 to 30 units/day) with that of prednisone (2 mg/kg/day). Response to therapy was determined by utilizing a comprehensive monitoring system and was defined as a complete cessation of spasms and disappearance of the hypsarrhythmic EEG pattern. A major difference between the effectiveness of ACTH and that of prednisone in stopping the spasms and improving the EEG pattern was not demonstrated. Nine patients responded to ACTH (five initial drug four crossover), and seven patients responded to prednisone (four initial drug, three crossover). Twelve responded within two weeks of initiation of therapy, and four within six weeks. Therapy was tapered and discontinued immediately after a response was obtained. Five patients had a relapse; four responded rapidly to a second course of therapy. Of the eight patients who failed to respond to hormonal therapy, seven were given clonazepam with no improvement.

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      2021, Epilepsy Research
      Citation Excerpt :

      Although the presence of hypsarrhythmia is often used as a diagnostic marker of the syndrome, there is low inter-rater reliability for identification of the pattern (Hussain et al., 2015; Mytinger et al., 2015) and it is not a predictor of outcome (Demarest et al., 2017). Overall, rates of sustained treatment response are low due to a paucity of effective first-line therapies and a high relapse rate (Hrachovy et al., 1983; Baram et al., 1996; Ito et al., 2002), and this is further complicated by diagnostic challenges and the subsequent use of inappropriate therapies in cases of misdiagnosis (O’Callaghan et al., 2011; Auvin et al., 2012). Computational EEG biomarkers of ES that are independent of the presence of hypsarrhythmia would help address these challenges by providing tools for objective—and perhaps more accurate—identification of the disease.

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    *

    Supported by Grant NS11535 and Contract NS-9-2321 from the National Institute of Neurological and Communicative Disorders and Stroke.

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