Clinical study on treatment of infantile spasms with incremental corticotrophin therapy

Abstract

Objective To summarize the efficacy and adverse reactions of incremental corticotrophin (ACTH) therapy in the treatment of infantile spasms (IS), and to provide new clinical treatment options. Methods The clinical data of 40 children with IS who were hospitalized in the Department of Neurology, Shanghai Children′s Medical Center, Shanghai Jiaotong University School of Medicine, treated with ACTH from January 2016 to January 2018 were collected and retrospectively analyzed.All the children were treated with intravenous infusion of ACTH with an initial dose 12.5 U/d for 3 days.If the spasms did not disappear, dosage of ACTH increased to 25.0 U/d for another 3 days.If the spasms could not yet be fully controlled, the dosage increased to 40.0 U/d, and the total course of treatment did not exceed 2 weeks.If the spasms disappeared at each dose stage or the course of treatment reached to 2 weeks, ACTH would be changed to Prednisone 2 mg/(kg·d) orally, which gradually decreased in 2 months.All children underwent electroencephalogram examination before and after treatment. Results Forty patients with IS were treated with ACTH increa-sing therapy.The disappearance rate of spasms was 40.0% (16/40 cases) totally, with 7.5% (3/40 cases) at the dosage phase of 12.5 U/d, 16.2% (6/37 cases) at the dosage stage of 25.0 U/d, and 22.6% (7/31 cases) at the dosage of 40.0 U/d.The disappearance rate of hypsarrhythmia on electroencephalogram was 60.0%(24/40 cases)generally, and 5.0%(2/40 cases), 10.8%(4/37 cases), 58.1%(18/31 cases), respectively at above different dosage phases, while 37.5% (15/40 cases) of the children had mild adverse reactions, mostly respiratory infections. Conclusions The short-term efficacy of the ACTH incremental therapy in the treatment of IS is positive, and the incidence of adverse reactions is low. Key words: Corticotrophin; Infantile spasms; Incremental therapy; Efficacy; Safety