Brain shrinkage and subdural effusion associated with ACTH administration

Area of Science:

• Pediatric Neurology
• Radiology
• Endocrinology

Background:

• Intractable epilepsy in children poses significant treatment challenges.
• Adrenocorticotropic hormone (ACTH) therapy is used for certain pediatric epilepsy syndromes.
• Potential side effects of long-term corticosteroid use require careful monitoring.

Purpose of the Study:

• To investigate the effects of synthetic ACTH-Z on brain volume in pediatric patients with intractable epilepsy.
• To assess the temporal dynamics of observed brain volume changes during and after ACTH-Z treatment.
• To identify potential risk factors for adverse neurological events associated with ACTH-Z therapy.

Main Methods:

• Sequential computed tomographic (CT) scans were performed on 11 pediatric patients (5 months to 7 years) undergoing synthetic ACTH-Z treatment.
• Brain volume changes were assessed over the course of therapy and during a follow-up period of 1-3 months.
• Clinical data, including age and occurrence of complications, were correlated with imaging findings.

Main Results:

• All 11 patients exhibited brain shrinkage during ACTH-Z therapy, with maximum effect observed within four weeks.
• Younger patients (under two years) showed more pronounced brain shrinkage compared to older children.
• Seven out of nine follow-up cases demonstrated near-complete recovery of brain volume after therapy cessation.
• Two patients developed subdural effusion as a complication of ACTH-Z treatment.

Conclusions:

• Synthetic ACTH-Z therapy for intractable pediatric epilepsy can lead to reversible brain shrinkage.
• Age is a significant factor influencing the severity of brain shrinkage.
• The observed effects are hypothesized to be related to corticosteroid-induced alterations in brain water and electrolyte balance.