Full-Length Original Research
Treatment of infantile spasms with very high dose prednisolone before high dose adrenocorticotropic hormone
Article first published online: 8 NOV 2013
Wiley Periodicals, Inc. © 2013 International League Against Epilepsy
Volume 55, Issue 1, pages 103–107, January 2014
How to Cite
Epilepsia, 55(1):103–107, 2014
- Issue published online: 21 JAN 2014
- Article first published online: 8 NOV 2013
- Manuscript Accepted: 30 SEP 2013
- Epilepsy Therapy Project
- Milken Family Foundation
- Paul A. Hughes Family Foundation
- William P. Kreisberg Memorial Fund
- Lundbeck, Inc
- Tuberous Sclerosis Alliance
- Today's and Tomorrow's Children Fund
- Novartis Pharmaceuticals Inc
- Department of Defense/Congressionally Directed Medical Research Program
- National Institutes of Health. Grant Numbers: R01 NS082649, K23 NS051637, P20 NS080199, U01 NS082320, R34 MH089299
- NIH NINDS. Grant Numbers: NS065783, NS045911, P20 NS080181
- West syndrome
This study investigated the short-term response to a standardized hormonal therapy protocol for treatment of infantile spasms.
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/m2/day) intramuscular adrenocorticotropic hormone (ACTH) for two additional weeks. Response was again determined by overnight video-EEG after ACTH therapy.
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.
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.