Efficacy assessment and follow-up study with different small doses of adrenocorticotropic hormone in treating infantile spasms
10.3760/cma.j.issn.2095-428X.2014.21.017
- VernacularTitle:不同小剂量促皮质素治疗婴儿痉挛症疗效评估及随访研究
- Author:
Zhijing WANG
;
Dong WANG
;
Xia LI
- Publication Type:Journal Article
- Keywords:
Adrenocorticotropic hormone;
Infantile spasms;
Follow-up study
- From:
Chinese Journal of Applied Clinical Pediatrics
2014;29(21):1661-1664
- CountryChina
- Language:Chinese
-
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 failing 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 electroencephalogram(EEG) and adverse reactions in 3 groups were compared and analyzed.Results Mter 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)] (x2 =10.011,6.624,all P < 0.05),respectively,while no significant difference was found between group A and group B as for seizure control,hypsarrhythmia EEG resolution,and cognitive function restoration (x2 =0.125,0.000,t =1.95,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)] (x2 =4.329,6.455,all P < 0.05),respectively.The incidence of adverse reactions in group A was lower than that in group B (x2 =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.