Adrenocorticotropic Hormone versus Pulsatile Dexamethasone in the Treatment of Infantile Epilepsy Syndromes

Haberlandt, Edda; Weger, Christine de; Sigl, S. Baumgartner; Rauchenzauner, Markus; Scholl‐Bürgi, Sabine; Rostásy, Kevin

doi:10.1016/j.pediatrneurol.2009.07.011

Cited by 39 publications

(45 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…22 In a small, retrospective Class IV study (n ϭ 18), spasms resolution at treatment day 10 was better with ACTH than dexamethasone. 23 Conclusion. Data are insufficient regarding the equivalence of other corticosteroids to ACTH (Class III and IV evidence).…”

Section: Other Forms Of Corticosteroids Are Other Forms Of Corticostmentioning

confidence: 99%

Evidence-based guideline update: Medical treatment of infantile spasms [RETIRED]

Mackay²,

Weiss³

et al. 2012

Neurology

299

277

View full text Add to dashboard Cite

Objective:To update the 2004 American Academy of Neurology/Child Neurology Society practice parameter on treatment of infantile spasms in children.Methods: MEDLINE and EMBASE were searched from 2002 to 2011 and searches of reference lists of retrieved articles were performed. Sixty-eight articles were selected for detailed review; 26 were included in the analysis. Recommendations were based on a 4-tiered classification scheme combining pre-2002 evidence and more recent evidence. Results:There is insufficient evidence to determine whether other forms of corticosteroids are as effective as adrenocorticotropic hormone (ACTH) for short-term treatment of infantile spasms. However, low-dose ACTH is probably as effective as high-dose ACTH. ACTH is more effective than vigabatrin (VGB) for short-term treatment of children with infantile spasms (excluding those with tuberous sclerosis complex). There is insufficient evidence to show that other agents and combination therapy are effective for short-term treatment of infantile spasms. Short lag time to treatment leads to better long-term developmental outcome. Successful short-term treatment of cryptogenic infantile spasms with ACTH or prednisolone leads to better long-term developmental outcome than treatment with VGB.Recommendations: Low-dose ACTH should be considered for treatment of infantile spasms.ACTH or VGB may be useful for short-term treatment of infantile spasms, with ACTH considered preferentially over VGB. Hormonal therapy (ACTH or prednisolone) may be considered for use in preference to VGB in infants with cryptogenic infantile spasms, to possibly improve developmental outcome. A shorter lag time to treatment of infantile spasms with either hormonal therapy or VGB possibly improves long-term developmental outcomes. Neurology ® 2012;78:1974-1980 GLOSSARY AAN ϭ American Academy of Neurology; ACTH ϭ adrenocorticotropic hormone; AE ϭ adverse effect; AED ϭ antiepileptic drug; BD ϭ Breslow-Day; CI ϭ confidence interval; ERG ϭ electroretinogram; FDA ϭ Food and Drug Administration; IVIg ϭ IV immunoglobulin; LEV ϭ levetiracetam; NZP ϭ nitrazepam; OR ϭ odds ratio; RCT ϭ randomized controlled trial; TPM ϭ topiramate; TRH ϭ thyrotropin-releasing hormone; TSC ϭ tuberous sclerosis complex; UKISS ϭ United Kingdom Infantile Spasms Study; VABS ϭ Vineland Adaptive Behavioral Scale; VGB ϭ vigabatrin; VPA ϭ valproic acid; ZNS ϭ zonisamide.

show abstract

Section: Other Forms Of Corticosteroids Are Other Forms Of Corticostmentioning

confidence: 99%

Evidence-based guideline update: Medical treatment of infantile spasms [RETIRED]

Mackay²,

Weiss³

et al. 2012

Neurology

299

277

View full text Add to dashboard Cite

show abstract

“…In a study by Haberlandt [62] (Class IV) 7 of 14 children (50 %) with West syndrome exhibited 100 % response (total cessation of the spasms) when 20 mg/m 2 /day dexamethasone was administered as pulse therapy for 3 days, with an interval of 4 weeks between each cycle. Every patient received at least five cycles.…”

Section: Different Forms Of Corticosteroidsmentioning

confidence: 99%

“…Prospective trials with larger numbers of patients would be needed to confirm these clinical observations. These two innovative approaches were partly motivated by cost, since the intravenous methylprednisolone/dexamethasone regimen had an estimated drug cost of US$200 compared with an estimated US$70,000 for treatment with ACTH in the US [62].…”

Section: Different Forms Of Corticosteroidsmentioning

confidence: 99%

Recent Advances in the Pharmacotherapy of Infantile Spasms

Riikonen

2014

CNS Drugs

View full text Add to dashboard Cite

Adrenocorticotrophic hormone (ACTH), oral corticosteroids and vigabatrin are now first-line treatments for infantile spasms in the US and Europe. There is now increased knowledge regarding the role of ACTH, corticosteroids and vigabatrin (e.g. efficacy, doses, side effects, treatment in specific aetiological subtypes of infantile spasms), and other antiepileptic drugs (i.e. topiramate, valproate, zonisamide, sulthiame, levetiracetam, lamotrigine, pyridoxine, ganaxolone), as well as adjunctive flunarizine and novel drugs not yet in clinical use for infantile spasms (i.e. pulse rapamycin and melanocortin receptor agonists). The existence of a latent period, weeks to months following a precipitating brain insult, raises the possibility of preventive interventions. Recent experimental data emerging from animal models of infantile spasms have provided optimism that new and innovative treatments can be developed, and knowledge that drug treatment can affect long-term cognitive outcome is increasing. The aim of this article is to review recent developments in the pharmacotherapy of infantile spasms and to highlight the practical implications of the latest research.

show abstract

“…The precise mechanism is still unknown, but it is suspected that steroids act on neurotransmitters, such as GABA and glutamate, and thus inhibits seizures [122]. Both GCs and ACTH act as anti-inflammatory mediators and suppresses immune responses [123]. Currently, ACTH and GCs have been successfully used in the treatment of some types of epilepsy, including LGS, myoclonic seizures, Parry Romberg's syndrome, and WS; but their efficacy and safety in treating other types of epilepsy are still need further investigation [124].…”

Section: Immunity and Anti-inflammatory Therapies In Epilepsymentioning

confidence: 99%

“…Dexamethasone was also of efficacy in controlling pediatric DRE [125]. When dexamethasone treatment preceded exposure to pilocarpine, the number of rats developing SE was reduced [126].…”

Section: Immunity and Anti-inflammatory Therapies In Epilepsymentioning

confidence: 99%

Modulation of Immunity and the Inflammatory Response: A New Target for Treating Drug-resistant Epilepsy

Líu²,

Qin³

2013

Current Neuropharmacology

View full text Add to dashboard Cite

Until recently, epilepsy medical therapy is usually limited to anti-epileptic drugs (AEDs). However, approximately 1/3 of epilepsy patients, described as drug-resistant epilepsy (DRE) patients, still suffer from continuous frequent seizures despite receiving adequate AEDs treatment of sufficient duration. More recently, with the remarkable progress of immunology, immunity and inflammation are considered to be key elements of the pathobiology of epilepsy. Activation of inflammatory processes in brain tissue has been observed in both experimental seizure animal models and epilepsy patients. Anti-inflammatory and immunotherapies also showed significant anticonvulsant properties both in clinical and in experimental settings. The above emerging evidence indicates that modulation of immunity and inflammatory processes could serve as novel specific targets to achieve potential anticonvulsant effects for the patients with epilepsy, especially DRE. Herein we review the recent evidence supporting the role of inflammation in the development and perpetuation of seizures, and also discuss the recent achievements in modulation of inflammation and immunotherapy applied to the treatment of epilepsy. Apart from medical therapy, we also discuss the influences of surgery, ketogenic diet, and electroconvulsive therapy on immunity and inflammation in DRE patients. Taken together, a promising perspective is suggested for future immunomodulatory therapies in the treatment of patients with DRE.

show abstract

Adrenocorticotropic Hormone versus Pulsatile Dexamethasone in the Treatment of Infantile Epilepsy Syndromes

Cited by 39 publications

References 25 publications

Evidence-based guideline update: Medical treatment of infantile spasms [RETIRED]

Evidence-based guideline update: Medical treatment of infantile spasms [RETIRED]

Recent Advances in the Pharmacotherapy of Infantile Spasms

Modulation of Immunity and the Inflammatory Response: A New Target for Treating Drug-resistant Epilepsy

Contact Info

Product

Resources

About