High-dose oral prednisolone for infantile spasms: An effective and less expensive alternative to ACTH

Kossoff, Eric H.; Hartman, Adam L.; Rubenstein, James E.; Vining, Eileen P.G.

doi:10.1016/j.yebeh.2009.01.023

Cited by 86 publications

(79 citation statements)

References 9 publications

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“…However, 3 of these studies involving 47 subjects provided enough raw data to recalculate the efficacy outcome of no spasms and no hypsarrhythmia, although not always confirmed by prolonged video-EEG monitoring. [17][18][19] The 3 remaining studies (involving 152 subjects) did not provide sufficient raw data for this calculation. [20][21][22] The median ages of infants in methodologically adequate studies were 7 months 15 and 8.4 months, 16 respectively.…”

Section: Resultsmentioning

confidence: 99%

Corticosteroids for the Treatment of Infantile Spasms

2012

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Adrenocorticotropic hormone (ACTH) and corticosteroids are the usual first-line treatment options for infantile spasms. Despite significant differences, these agents are often lumped together in this context. There is a need to systematically explore the efficacy of corticosteroids in the treatment of infantile spasms, especially in comparison to ACTH. This review identified and analyzed corticosteroid clinical trials and summarized their short-term efficacy and tolerability. Primary outcome was cessation of spasms and abolition of hypsarrhythmia on prolonged video electroencephalographic monitoring. Eight corticosteroid clinical trials were found with only 2 fulfilling the criteria for adequate design. The weighted-mean efficacy of corticosteroids to achieve primary outcome was 31% for these 2 methodologically adequate studies. Including reanalyzed data from 3 other studies, the corticosteroid efficacy was found to be 42%. On the basis of the available evidence, the efficacy of high-dose corticosteroids is similar to low-dose ACTH and inferior to high-dose ACTH, the current standard treatment.

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Section: Resultsmentioning

confidence: 99%

Corticosteroids for the Treatment of Infantile Spasms

2012

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“…It should be noted that large doses of prednisolone were used in the latter study. Large doses of prednisolone (40-60 mg/day) have recently been given with high response rates of 21/30 (70 %) [22], 51/72 (70 %) [58], 28/57 (49 %) [59] and 10/15 (66 %) [60]. The studies were not been evidencebased studies except for one [22].…”

Section: Different Forms Of Corticosteroidsmentioning

confidence: 99%

Recent Advances in the Pharmacotherapy of Infantile Spasms

Riikonen

2014

CNS Drugs

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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.

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“…For patients with other etiologies, both ACTH and oral corticosteroids have some efficacy. Clinicians choose a therapy based upon effectiveness but resource allocation also needs to be considered (37)(38)(39). Studies have compared doses of each agent and duration of treatment, but there is no universally agreed-upon protocol.…”

Section: Therapeutic Targets Translational Opportunities and Prognosismentioning

confidence: 99%