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Cerebral blood flow during ACTH therapy: especially diurnal changes within the first week of therapy
1Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
Insights
Adrenocorticotrophic hormone (ACTH) therapy in children with epilepsy significantly reduces cerebral blood flow (CBF) in the short term. CBF gradually recovers over eight weeks of treatment.
Area of Science:
- Pediatric Neurology
- Neuropharmacology
- Vascular Physiology
Background:
- Epilepsy treatment often involves adrenocorticotrophic hormone (ACTH).
- Understanding ACTH's effects on cerebral hemodynamics in children is crucial.
- Previous research has not fully elucidated ACTH's impact on cerebral blood flow (CBF) in pediatric epilepsy.
Purpose of the Study:
- To evaluate the impact of ACTH therapy on cerebral blood flow (CBF) in children with epilepsy.
- To quantify changes in internal carotid artery blood velocity as indicators of CBF.
- To assess the temporal dynamics of CBF alterations during ACTH treatment.
Main Methods:
- Utilized Doppler ultrasound to measure cerebral blood flow (CBF) indices.
- Monitored average maximal blood velocity (A/L) and maximal end-diastolic blood velocity (d) of the internal carotid artery.
- Assessed CBF changes at various time points during ACTH therapy, including 30 minutes, 24 hours, and weekly intervals up to 8 weeks.
Main Results:
- ACTH therapy led to significant decreases in A/L and d, indicating reduced CBF.
- CBF reductions were observed as early as 30 minutes post-ACTH injection.
- These reductions persisted for the initial four days, showing a stepwise decline, with a nadir at one week and recovery by eight weeks.
Conclusions:
- ACTH therapy induces a significant, temporary reduction in cerebral blood flow (CBF) in pediatric epilepsy patients.
- The observed CBF changes suggest a need for further investigation into cerebral metabolism.
- Understanding the mechanism of ACTH-induced CBF reduction is essential for optimizing epilepsy treatment.
Abstract:
Changes in cerebral blood flow (CBF) were evaluated in children with epilepsy treated with adrenocorticotrophic hormone (ACTH) by the Doppler ultrasound method. The average maximal blood velocity (A/L) and maximal end-diastolic blood velocity (d) of the internal carotid artery, as indices of CBF, significantly decreased during ACTH therapy. These values had already decreased at 30 minutes after the first injection of ACTH and were hardly restored 24 hours later just before the next injection. Such changes repeatedly occurred for the first four days of therapy so that the reductions in the A/L and d values proceeded in a stepwise manner. These values became minimum at around one week after initiation of the therapy and then gradually increased, returning to the original levels by the 8th week of therapy. Investigation of the changes in cerebral metabolism seemed to be the next step for elucidation of the mechanism underlying the CBF reduction during ACTH therapy.