High-dose corticotropin (ACTH) versus prednisone for infantile spasms: a prospective, randomized, blinded study

Area of Science:

• Pediatric Neurology
• Neuroimmunology
• Clinical Electrophysiology

Background:

• Infantile spasms (IS) are a severe epilepsy syndrome in infants.
• Adrenocorticotropic hormone (ACTH) and prednisone are standard IS treatments.
• High-dose ACTH has potential side effects, but may be more effective than prednisone.

Purpose of the Study:

• To compare the efficacy of high-dose ACTH versus prednisone in treating infantile spasms.
• To assess the suppression of clinical spasms and hypsarrhythmic electroencephalogram (EEG) in IS patients.

Main Methods:

• Prospective, randomized, single-blinded study design.
• 29 infants with IS were enrolled and treated for 2 weeks.
• Response defined by cessation of spasms and elimination of hypsarrhythmia on EEG.

Main Results:

• High-dose ACTH achieved an 86.6% response rate (13/15 infants).
• Prednisone achieved a 28.6% response rate (4/14 infants).
• The difference in efficacy between ACTH and prednisone was statistically significant.

Conclusions:

• A 2-week course of high-dose ACTH is superior to prednisone for treating IS.
• ACTH demonstrated better clinical and EEG response rates compared to prednisone.