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ACTH therapy in infantile spasms: side effects.

R Riikonen, M Donner

    Archives of Disease in Childhood
    |September 1, 1980
    PubMed
    Summary

    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.

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    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.

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