Comparison of the efficacy of adrenocorticotropic hormone and Methylprednisolone in the treatment of infantile spasms

Abstract

Objective To observe the curative effect of Adrenocorticotropic hormone(ACTH) for infantile spasms. Methods One hundred and two children with infantile spasms were enrolled at the Pediatrics of the Third Affiliated Hospital of Xinxiang Medical University from July 2013 to July 2015 and analyzed, retrospectively.Their age ranged from 45 days to 4 years old.According to the digital method, they were divided randomly into the preferred Met-hylprednisolone group including 21 cases and ACTH group including 28 cases, and another 28 cases of Methylprednisolone group and 25 cases of ACTH group as non-preferred cases.A dose of 20-30 mg/(kg·d) Vitamin B6 was dripped each day for 3 days.If it was ineffective, 1 U/kg ACTH was pumped once daily for over 8 h each time for 2 weeks.Then the curative effect was evaluated again.If it was effective, the treatment could be continued for another 2 weeks, so a total course of treatment was 4 weeks.If it was still ineffective, a dose of ACTH would be increased to 2 U/kg.The total treatment course was 4 weeks and the maximum was 40 U/time.The Methylprednisolone group, with 20 mg/(kg·d)for 3-5 days, were assigned as controls.And then both groups switched to oral Methylprednisolone treatment, 1.5-2.0 mg/(kg·d)at 6 to 8 hours every morning.After 4-8 weeks drug dosage was gradually reduced and discontinued, and the overall courses lasted for 8-12 weeks.Then changes in spasm attack, electroencephalogram, routine blood test, functions of liver and kidney and electrolyte were detected before and after ACTH and Methylprednisolone treatment. Results The total control rate was 67.86%(19/28 cases), effective rate was 96.43%(27/28 cases) and the total control time was(6.47±1.45) days in preferred ACTH group, while in the non-preferred ACTH group the total control rate, effective rate and the total control time were 62.5%(15/25 cases), 92.0%(23/25 cases) and (10.73±2.09)days, respectively.The total control rate, effective rate and the total control time in the preferred ACTH group were better than those in the non-preferred ACTH group Methylprednisolone group, and non-preferred Methylprednisolone group.The total control rate of encephlogram had a trend to decrease with time extension in the four groups, while it was controlled better in the early stage in the ACTH group and Methylprednisolone group.The total control rate of encephlogram decreased slowly in the ACTH group and the non-preferred ACTH group.There was no difference in the adverse reaction among the four groups.The recurrence rates of ACTH group was less than those of other 3 groups. Conclusion The treatment efficacy with ACTH for initial and noninitial infantile spasms was better than that of Methylprednisolone. Key words: Adrenocorticotropic hormone; Methylprednisolone; Infantile spasms; Efficacy