Use of ACTH and prednisolone in infantile spasms: Experience from a developing country

Azam, Matloob; Bhatti, N.; Krishin, Jai

doi:10.1016/j.seizure.2005.08.009

Cited by 30 publications

(43 citation statements)

References 24 publications

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“…One reason for this inconsistency could be that the aforestated studies have used higher starting doses for ACTH, with 75 IU being the most common dose, as opposed to our study, where the starting dose for 40 IU in almost all cases. This can be further substantiated by two studies that report that ACTH was effective at higher doses, based both on response rate and plasma hormone data [6,28-30]. …”

Section: Discussionmentioning

confidence: 83%

“…Despite all the advances in understanding the various treatment options available, infantile spasms still remains an elusive childhood disease that is difficult to treat with the overall prognosis being dismal. The search for an ideal drug therefore continues - a drug that is not only effective in controlling spasms, has minimal side effects and improves long term outcome, but is also easily accessible to most patients [6]. …”

Section: Resultsmentioning

confidence: 99%

“…Studies on experience with ACTH and Vigabatrin from Pakistan and neighboring regions are lacking. To date, there has been only one study from Pakistan reporting the use of ACTH and prednisolone [6]. There has been no study exploring the efficacy of Vigabatrin in Pakistan.…”

Section: Introductionmentioning

confidence: 99%

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Clinical profile and treatment of infantile spasms using vigabatrin and ACTH - a developing country perspective

et al. 2010

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BackgroundInfantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of patients with infantile spasms from Pakistan.MethodsAll patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned above. The type of drug distribution was random according to the availability, cost and ease of administration.ResultsFifty six cases fulfilled the inclusion criteria. 62.5% were males. Mean age at onset of seizures was 5 ± 1.4 months. Fifty two (92.8%) patients demonstrated hypsarrythmia on electroencephalography. 64.3% cases were identified as symptomatic while 19.6% were cryptogenic and 16.1% were idiopathic. Eighteen patients received ACTH while 38 patients received Vigabatrin as first line therapy. Initial response to first line therapy was similar (50% for ACTH and 55.3% for Vigabatrin). Overall, the symptomatic and idiopathic groups responded better to Vigabatrin. The relapse rate was higher for ACTH as compared to Vigabatrin (55.5% vs. 33.3%) when considering the first line therapy. Four patients evolved to Lennox-Gastaut variant; all of these patients had initially received Vigabatrin and then ACTH.ConclusionVigabatrin and ACTH showed no significant difference in the initial treatment of infantile spasms. However, patients receiving ACTH were 1.2 times more likely to relapse as compared to the patients receiving Vigabatrin when considering monotherapy. We suggest that Vigabatrin should be the initial drug of choice in patients presenting with infantile spasms. However, larger studies from developing countries are required to validate the therapeutic trends observed in this study.

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Section: Discussionmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

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Clinical profile and treatment of infantile spasms using vigabatrin and ACTH - a developing country perspective

et al. 2010

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“…16,25,26 The United Kingdom Infantile Spasms study using parental report for outcome assessment compared low-dose synthetic truncated ACTH analog, ACTH 1-24 (tetracosactide) 40 IU every other day, with high-dose prednisolone 40 mg/d and nested within comparison of vigabatrin versus hormonal treatment. 20 Nineteen of 25 patients in the ACTH arm achieved Baram, 1996 15 14 Prednisone 2 mg/kg/d in 2 divided doses for 2 wk All criteria Not reported Hrachovy, 1983 16 12 Prednisone 2 mg/kg/d for 2 wk (extended to 6 wk in nonresponders)…”

Section: Discussionmentioning

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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“…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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Use of ACTH and prednisolone in infantile spasms: Experience from a developing country

Abstract: No significant difference was seen in the final outcome in both treatment groups. Since prednisolone is inexpensive, easily available and given orally, it is the preferred mode of therapy.

Cited by 30 publications

References 24 publications

Clinical profile and treatment of infantile spasms using vigabatrin and ACTH - a developing country perspective

Clinical profile and treatment of infantile spasms using vigabatrin and ACTH - a developing country perspective

Corticosteroids for the Treatment of Infantile Spasms

Recent Advances in the Pharmacotherapy of Infantile Spasms

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