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Published on: November 21, 2013
Adrenocorticotropic Hormone (ACTH)-Induced Dyskinesias in Infantile Spasms: A Video Case Report
Ana C S Crippa1, Dafne L Bayer1, Luciana de Paula Souza2
1Neurology Pediatric Unit, Universidade Federal do Paraná, Curitiba, PR, Brazil.
Insights
Adrenocorticotropic hormone (ACTH) therapy for infantile spasms can cause dyskinetic movements, which are not seizures. These movements resolve after treatment completion, highlighting a potential misdiagnosis in infantile spasms management.
Area of Science:
- Neurology
- Pediatrics
- Endocrinology
Background:
- Infantile spasms is a severe epilepsy syndrome in infants.
- Adrenocorticotropic hormone (ACTH) is a primary treatment, but has side effects.
- Adverse effects of ACTH in infantile spasms are not well-documented.
Observation:
- Four infants treated with ACTH developed involuntary, asymmetric movements.
- These movements resembled dyskinesia, not epileptic seizures.
- Electroencephalography (EEG) showed no epileptic activity during these episodes.
Findings:
- ACTH therapy can induce dyskinetic movements in infants with infantile spasms.
- These movements are distinct from infantile spasms seizures.
- Involuntary movements ceased post-ACTH treatment.
Implications:
- Recognizing ACTH-induced dyskinesia is crucial to avoid misdiagnosis.
- This distinction prevents inappropriate escalation of epilepsy treatment.
- Further research into ACTH's neurological side effects is warranted.
Abstract:
BACKGROUND Infantile spasms is an age-specific epilepsy syndrome that occurs during infancy and is characterized by tonic and/or flexor-extensor spasms, hypsarrhythmia on electroencephalography (EEG), and neurodevelopmental regression. Adrenocorticotropic hormone (ACTH) is considered one of the main therapies for the treatment of infantile spasms, but despite its great efficacy, it is still associated with potential adverse effects. CASE REPORT Four patients previously diagnosed with infantile spasms were treated with ACTH following the usual treatment regimen. All patients developed asymmetric, involuntary movements, with phenomenology characteristic of dyskinesia. The patients did not manifest loss of consciousness, and the EEG did not show epileptic activity during those episodes. In all cases, involuntary movements disappeared after the completion of the hormonal therapy. CONCLUSIONS The adverse effect of hormonal therapy in infantile spasms is not well known in the literature and could be mistaken as seizures, leading to inappropriate management.
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