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Focal seizures during adrenocorticotropic hormone therapy in a school-aged boy: a case report
Yoshitaka Ota1, Shuichi Shimakawa2, Hikaru Tsuda-Kitahara3
1Department of Pediatrics, Hirakata Municipal Hospital, Hirakata, Osaka, Japan.
Insights
Adrenocorticotropic hormone therapy can trigger new focal seizures in school-aged children with epilepsy, even those with intractable conditions. This side effect was observed in a 14-year-old patient with posttraumatic epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacovigilance
Background:
- Adrenocorticotropic hormone (ACTH) therapy is a known treatment for infantile spasms, including West syndrome.
- Previous reports indicate ACTH therapy can induce seizures in children.
- This case expands on the known side effects of ACTH therapy.
Observation:
- A 14-year-old Japanese male with posttraumatic epilepsy experienced intractable focal seizures.
- ACTH therapy was initiated for his epilepsy.
- New focal seizures, characterized by specific automatisms, emerged on day 10 of treatment.
Findings:
- The patient developed distinct focal seizures with left arm contractions and complex automatisms.
- These seizures were transient, resolving after diazepam administration.
- The seizures did not recur during over two years of follow-up.
Implications:
- Adrenocorticotropic hormone-induced seizures may occur in older children than previously documented.
- This phenomenon can be observed in children with intractable epilepsy beyond infantile spasms.
- Highlights the importance of monitoring for new seizure types during ACTH therapy in diverse pediatric epilepsy populations.
Background:
Adrenocorticotropic hormone therapy for infantile spasms, including West syndrome, has been previously reported to induce seizures. We present the findings for a school-aged child with epilepsy who developed new focal seizures during adrenocorticotropic hormone therapy.
Case Presentation:
The Japanese patient had posttraumatic epilepsy and developed intractable focal seizures at the age of 13 years. Adrenocorticotropic hormone therapy was administered when the patient was 14 years of age. On day 10 of treatment, he developed new focal seizures, which were characterized by left arm contractions followed by movements of touching things with his right hand and writhing and rocking his body left and right and back and forth as automatisms. The focal seizures clustered for 40 minutes and disappeared after suppository administration of 10 mg diazepam. These focal seizures did not reoccur after more than 2 years of follow-up.
Conclusion:
Adrenocorticotropic hormone-induced seizures can occur in children older than previously reported, and can occur in children with intractable seizures other than epileptic spasms.
