Related Experiment Videos
ACTH therapy in infantile spasms: side effects
Insights
Adrenocorticotropic hormone (ACTH) treatment for infantile spasms caused significant side effects in 37% of children, including infections and electrolyte disturbances. Careful monitoring and reconsidering high dosages are crucial due to potential severe complications and mortality.
Area of Science:
- Pediatric Neurology
- Endocrinology
Background:
- Infantile spasms (IS) are a severe form of epilepsy in infants.
- Adrenocorticotropic hormone (ACTH) has been a treatment option for IS.
Observation:
- A retrospective study analyzed 162 children treated with ACTH for infantile spasms between 1960-1976.
- Treatment outcomes and adverse events were documented.
Findings:
- 37% of children experienced pronounced side effects, with a 4.9% mortality rate.
- Common complications included infections (septic, pneumonia, urinary, gastrointestinal), hypertension, osteoporosis, and electrolyte disturbances.
- Higher ACTH doses (120 units) were associated with significantly more infections than lower doses (40 units).
- Severe complications like intracerebral hemorrhages, oliguria, hyperkalemia, and tubular necrosis were observed.
Implications:
- ACTH treatment for infantile spasms carries a substantial risk of severe side effects, potentially underestimated in previous assumptions.
- Close patient monitoring before, during, and after ACTH therapy is essential.
- The efficacy versus risk of very high-dose ACTH regimens warrants critical re-evaluation.
Abstract:
162 children with infantile spasms were treated with ACTH at the Children's Hospital, Helsinki, and at the Aurora Hospital, Helsinki, during 1960--76. In a large proportion (37%) of the children the treatment caused pronounced side effects, and the mortality was 4.9%. The most common complications were infections: septic infections, pneumonias, and urinary and gastrointestinal infections. Other side effects were arterial hypertension (11), osteoporosis (2), hypokalaemic alkalosis (2), and other marked electrolyte disturbances (10). In children necropsy showed fresh intracerebral haemorrhages. Four children developed oliguria and hyperkalaemia during and after withdrawal of ACTH. One of them had tubular necrosis confirmed by renal biopsy. Infections were significantly more common with large doses (120 units) of ACTH than with small ones (40 units). It is concluded that side effects, even severe ones, are more common during treatment than had been assumed. Careful watch is important before and after treatment. The benefit of very high dosages should also be reconsidered.