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The treatment of infantile spasms by child neurologists
1Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City.
Insights
Corticotropin (ACTH) is the preferred first-line treatment for infantile spasms, with consistent management observed among pediatric neurologists. This uniformity aids in designing future clinical trials for novel infantile spasms therapies.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Therapeutics
Background:
- Infantile spasms (IS) is a severe epilepsy syndrome requiring effective treatment.
- Limited data exists on the most utilized and clinically relevant IS treatment regimens.
- Understanding current practices is crucial for designing clinical trials of new IS therapies.
Purpose of the Study:
- To identify the most commonly used treatment methods for infantile spasms.
- To establish the practical importance of current treatment strategies in clinical trial design.
Main Methods:
- A 1991 survey was distributed to Child Neurology Society members regarding IS treatment.
- Telephone follow-up was conducted on a sample of non-respondents.
- Response rate was 58.3%.
Main Results:
- Corticotropin (ACTH) is the first-choice treatment for 88% of respondents.
- Common ACTH dosage: 40 IU/day for 1-2 months.
- Valproic acid and oral corticosteroids are alternative treatments.
- Reported side effects include cushingism, behavioral changes, hypertension, and infections.
- Treatment patterns were consistent across various respondent demographics and practice types.
Conclusions:
- A significant uniformity exists in the management of infantile spasms among child neurologists.
- This consensus supports the use of ACTH as a benchmark in clinical trials for new IS treatments.
- Current treatment practices provide a foundation for future research into infantile spasms therapies.
Abstract:
Infantile spasms is a refractory seizure disorder for which a number of different treatment regimens are available. No information is available on which treatment regimens are most widely used and which would be of practical importance in designing clinical trials to determine efficacy of new treatments. We proceeded to gather data on the most commonly employed methods of treating infantile spasms. A survey was mailed in 1991 to all junior, active, and emeritus members of the Child Neurology Society asking details about the treatment of infantile spasms. Telephone follow-up on a random sample of nonresponders was made. The total response rate was 58.3%. Most respondents who treat infantile spasms use corticotropin (ACTH) as their drug of first choice (88%). The most frequently used dosage was 40 IU per day, and the most frequent duration of treatment was 1 to 2 months. The most frequently reported side effects of ACTH or oral corticosteroid treatment were cushingism, behavior changes or irritability, hypertension, topical infections, and systemic infections. Of those not using ACTH, valproic acid was the next most commonly employed agent, followed by oral corticosteroids. The results were similar for all respondents regardless of age, sex, type of practice, number of cases of infantile spasms seen, location (United States or abroad) or whether the survey was completed by mail or telephone. These data suggest that there is a relative uniformity among child neurologists in the management of infantile spasms despite the publication of many alternative treatment strategies.