Cerebral atrophy following ACTH therapy

Area of Science:

• Neurology
• Pediatric Neurology
• Neuroimaging

Background:

• Infantile spasms and Lennox-Gastaut syndrome are severe childhood epilepsy disorders.
• Adrenocorticotropic hormone (ACTH) therapy is a common treatment for these conditions.
• Understanding the neurological effects of ACTH therapy is critical for patient management.

Observation:

• Cerebral atrophy, characterized by ventricular and sulcal enlargement, was assessed in 15 patients before and after ACTH therapy.
• Pre-treatment imaging revealed mild ventricular and sulcal enlargement in 73.3% of patients.
• Post-treatment observation showed increased enlargement in most patients shortly after ACTH administration.

Findings:

• Cerebral atrophy was reversible in most patients within one month of discontinuing ACTH therapy.
• However, three patients exhibited irreversible cerebral atrophy.
• One patient developed chronic subdural effusion, a potential complication of ACTH treatment.

Implications:

• ACTH therapy for infantile spasms and Lennox-Gastaut syndrome can induce reversible cerebral volume changes.
• The potential for irreversible atrophy and complications like subdural effusion necessitates vigilant patient monitoring during treatment.
• Further research into the mechanisms and long-term consequences of ACTH-induced brain changes is warranted.