Higher dosage and longer duration of treatment correlate with higher incidence of side effects.
Side effects are common and include hypertension (up to 37%), irritability (37%-100%), infection (14%), and cerebral atrophy (62%). The 2004 American Academy of Neurology (AAN) and CNS practice parameter on the medical treatment of infantile spasms concluded that ACTH is probably effective for the short-term treatment of infantile spasms and that VGB is possibly effective for the short-term treatment of infantile spasms and for treatment of children with TS.11Ī 2012 AAN evidence-based guideline, which updated the 2004 parameter, reported that ACTH or VGB may be useful for short-term treatment of infantile spasms, with ACTH being more effective than VGB, excluding cases with TS.12Īccording to the 2012 guideline, there is insufficient evidence to determine whether other forms of corticosteroids are as effective as ACTH.12 There is also insufficient evidence to recommend other agents or combination therapy as being effective in the short-term therapy of infantile spasms.12 Adrenocorticotropic HormoneĪCTH is given as an intramuscular injection, and different epilepsy centers show considerable variability in dosage (high vs low), formulation (natural ACTH in the United States vs synthetic ACTH in Canada, Japan, and Europe), and duration of therapy.
There is considerable variation in the management of infantile spasms, as evidenced by the US Consensus Report and a recent survey done on the current evaluation and treatment of infantile spasms among members of the Child Neurology Society (CNS).9,10 According to these sources, most neurologists use adrenocorticotrophic hormone (ACTH) as their preferred first-line treatment for infantile spasms not caused by TS and vigabatrin (VGB) as the first-line treatment of infantile spasms caused by TS.9,10
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