ACTH and prednisone in childhood seizure disorders

Snead, O. Carter; Benton, John W.; Myers, Gary J.

doi:10.1212/wnl.33.8.966

Cited by 166 publications

(104 citation statements)

References 0 publications

Supporting

Mentioning

100

Contrasting

Order By: Relevance

“…This was not predicted by animal models. Likewise, adrenocorticotrophin hormone (ACTH) has little role in treating seizures in adults, but is quiet effective in the treatment of infantile spasms, an epilepsy syndrome confined to children [63,64].…”

Section: Developmental Animal Modelsmentioning

confidence: 99%

Choosing the Correct Antiepileptic Drugs: From Animal Studies to the Clinic

Holmes¹,

Zhao²

2008

Pediatric Neurology

View full text Add to dashboard Cite

Epilepsy is a chronic condition caused by an imbalance of normal excitatory and inhibitory forces in the brain. Antiepileptic drug therapy has been directed primarily toward reducing excitability through blockage of voltage-gated Na + or Ca 2+ channels, or increasing inhibition through enhancement of γ-aminobutyric acid currents. Prior to clinical studies, putative antiepileptic drugs are screened in animals, usually rodents. Maximal electrical shock, pentylenetetrazol, and kindling are typically used as non-mechanistic screens for antiseizure properties and the rotorod test for assessing acute toxicity. While antiseizure drug screening has been successful in bringing drugs to the market and improving our understanding of the pathophysiology of seizures, it should be emphasized that the vast majority of drug screening occurs in mature male rodents and involves models of seizures, not epilepsy. Effective drugs in acute seizures may not be effective in chronic models of epilepsy. Seizure type, clinical and electroencephalographic phenotype, syndrome, and etiology are often quite different in children with epilepsy than adults. Despite these age-related unique features, drugs used in children are generally the same as used in adults. As awareness of the unique features of seizures during development increases, it is anticipated that more drug screening in the immature animal will occur.

show abstract

Section: Developmental Animal Modelsmentioning

confidence: 99%

Choosing the Correct Antiepileptic Drugs: From Animal Studies to the Clinic

Holmes¹,

Zhao²

2008

Pediatric Neurology

View full text Add to dashboard Cite

show abstract

“…Neonatal administration of exogenous corticosteroids promotes glucose homeostasis and, thus, protects the brain from hypoglycemiainduced injury (120). Lastly, ACTH and prednisone can be enormously valuable in the treatment of early childhood epilepsy, particularly infantile spasms (121,122). If untreated, repeated seizures may cause serious brain damage (123).…”

Section: Implications For Humansmentioning

confidence: 99%

The Impact of Corticosteroids on the Developing Animal

Edwards

Burnham

2001

Pediatr Res

View full text Add to dashboard Cite

The following is the fifth in our series of review articles on the developmental biology of the nervous system and its relation to diseases and disorders that are found in newborn infants and children. In this article Drs. Edwards Infants are subjected to both endogenous and exogenous corticosteroids in the pre-and postnatal periods. Stress to the mother before birth, or to the child postpartum, can give rise to high, chronic endogenous corticosteroid levels caused by activation of the hypothalamic-pituitary-adrenal (HPA) axis. Physician-administered exogenous corticosteroids are also used in the management of a wide spectrum of pre-and postnatal conditions. The long-term effects of corticosteroids in developing humans are not well known. Studies in animals, however, indicate that both natural stress and exogenous corticosteroids can have longlasting and deleterious effects on the body, brain, behavior, and hypothalamic-pituitary-adrenal axis of developing infants. These data suggest that exogenous corticosteroids should be administered with caution, after careful benefit/risk analyses, and that, as far as possible, the developing brain should be protected against the effects of pre-and postnatal stress. Abbreviations: HPA, hypothalamic-pituitary-adrenal axis PVN, paraventricular nucleus CRH, corticotropin-releasing hormone POMC, proopiomelanocortin GR, glucocorticoid receptor MR, mineralocorticoid receptors GABA, gamma amino butyric acid MHC, major histocompatibility complex 11␤-HSD, 11␤-hydroxysteroid dehydrogenase Infants are subjected to both endogenous and exogenous corticosteroids in the pre-and postnatal periods. When pregnant women undergo prolonged stress, for instance, such as that caused by family discord or the death of a spouse, the unborn infant is subjected to high, chronic levels of endogenous corticosteroids (1, 2). This is a result of repeated activation of the mother's HPA axis (1). Postnatally, traumatic events in the child's life give rise to high, chronic corticosteroid levels, resulting from activation of the child's own HPA axis (3).Exogenous glucocorticoids are also used in the management of a wide spectrum of pediatric diseases. Prenatally-and in

show abstract

“…providing class I, one providing class II, and three providing class III evidence [16][17][18][19][20] ; four were prospective open-label trials providing class III and class IV evidence [21][22][23][24] (table 1); and five were retrospective case series, also providing class IV evidence [25][26][27][28][29] (table 2). Only one class II study was placebo controlled, 17 and two were crossover studies using prednisone (class II) 17 or vigabatrin (class III).…”

mentioning

confidence: 99%

“…22 The majority of studies on the use of ACTH in infantile spasms are retrospective. Five studies meeting selection criteria were analyzed, providing class IV evidence with numbers ranging from 25 to 166 children [25][26][27][28][29] (see table 2). Response rates for cessation of spasms ranged from 59 to 100% and resolution of hypsarrhythmia from 57 to 97%, but relapse rates ranged from 9 to 62%.…”

mentioning

confidence: 99%

Practice Parameter: Medical Treatment of Infantile Spasms

Weiss²,

et al. 2004

Self Cite

View full text Add to dashboard Cite

Abstract-Objective:To determine the current best practice for treatment of infantile spasms in children. Methods: Database searches of MEDLINE from 1966 and EMBASE from 1980 and searches of reference lists of retrieved articles were performed. Inclusion criteria were the documented presence of infantile spasms and hypsarrhythmia. Outcome measures included complete cessation of spasms, resolution of hypsarrhythmia, relapse rate, developmental outcome, and presence or absence of epilepsy or an epileptiform EEG. One hundred fifty-nine articles were selected for detailed review. Recommendations were based on a four-tiered classification scheme. Results: Adrenocorticotropic hormone (ACTH) is probably effective for the short-term treatment of infantile spasms, but there is insufficient evidence to recommend the optimum dosage and duration of treatment. There is insufficient evidence to determine whether oral corticosteroids are effective. Vigabatrin is possibly effective for the short-term treatment of infantile spasm and is possibly also effective for children with tuberous sclerosis. Concerns about retinal toxicity suggest that serial ophthalmologic screening is required in patients on vigabatrin; however, the data are insufficient to make recommendations regarding the frequency or type of screening. There is insufficient evidence to recommend any other treatment of infantile spasms. There is insufficient evidence to conclude that successful treatment of infantile spasms improves the long-term prognosis. Conclusions: ACTH is probably an effective agent in the short-term treatment of infantile spasms. Vigabatrin is possibly effective. NEUROLOGY 2004;62:1668 -1681 West syndrome 1 is a unique, age-specific epilepsy of early infancy. Infantile spasms are distinct from myoclonic and tonic seizures.2 They are characterized by an initial contraction phase followed by a more sustained tonic phase. They can be divided into three types (flexor, extensor, and mixed flexor-extensor spasms), and they can also be asymmetrical.2 The EEG characteristically demonstrates hypsarrhythmia, and onset of spasms is frequently associated with neurodevelopmental regression. The incidence of infantile spasms is

show abstract

ACTH and prednisone in childhood seizure disorders

Cited by 166 publications

References 0 publications

Choosing the Correct Antiepileptic Drugs: From Animal Studies to the Clinic

Choosing the Correct Antiepileptic Drugs: From Animal Studies to the Clinic

The Impact of Corticosteroids on the Developing Animal

Practice Parameter: Medical Treatment of Infantile Spasms

Contact Info

Product

Resources

About