Abstract
Objective To investigate the efficacy and optimal dose of adrenocorticotropic hormone(ACTH) in treatment of infantile spasms(IS). Methods Sixty patients with IS were randomly divided into group A (ACTH 20 IU/d, n=20), group B (ACTH 40 IU/d, n=20) and group C (Depakine syrup, n=20) in a prospective randomized study.Patients in group A and group B were given ACTH in the dose of 20 IU/d and 40 IU/d for 2 weeks, respectively.After 2 weeks of treatment, ACTH administration was replaced by oral prednisone if the seizure frequency decreased by 50.0% or less.Patients showing incomplete control of epilepsy(seizure frequency reduction less than 50.0%) or fai-ling to respond to treatment were continuously treated with the original amount of ACTH for another 2 weeks, then ACTH was replaced by oral prednisone.Patients in group C were treated with the combination regimen of oral clonazepam and Depakine syrup routinely.All participants were followed up by 0.5-3.0 years.The differences in clinical efficacy, changes in electroen cephalogram(EEG) and adverse reactions in 3 groups were compared and analyzed. Results After 4 weeks of treatment, the total effective rates(TER) and EEG remission rate (ERR) in group A [TER: 75.0%(15/20 cases), ERR: 40.0%(8/20 cases)] and group B [TER: 70.0%(14/20 cases), ARE: 45.0%(9/20 cases)] were significantly higher than those in group C[TER: 30.0%(6/20 cases), ERR: 10.0%(2/20 cases)](χ2=10.011, 6.624, all P 0.05). During follow-up study, the TER and ERR in group A [TER: 30.0%(16/20 cases), ERR: 35.3%(6/17 cases)] and group B [TER: 30.0%(6/20 cases), ARE: 37.5%(6/16 cases)] were also significantly higher than those in group C [TER: 5.0%(1/20 cases), ARE: 5.9%(1/17 cases)] (χ2=4.329, 6.455, all P<0.05), respectively.The incidence of adverse reactions in group A was lower than that in group B (χ2=3.956, P<0.05). Conclusions ACTH proves to be an effective drug for the treatment of IS.Administration of ACTH in the dose of 20 IU/d for 2 weeks seems to be an optimal treatment recipe with remarkable efficacy with fewer adverse effects and may be worthy of clinical trials in a larger cohort. Key words: Adrenocorticotropic hormone; Infantile spasms; Follow-up study
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