| High-dose corticotropin (ACTH) versus prednisone for infantile spasms: a prospective, randomized, blinded study. | |
MedLine Citation:
|
PMID: 8604274 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To compare the efficacy of corticotropin (ACTH) (150 U/m2/day) and prednosone (2 mg/kg/day) given for 2 weeks, in suppressing clinical spasms and hypsarrhythmic electroencephalogram (EEG) in infantile spasms (IS). AACTH and prednisone are standard treatments for IS. ACTH at high doses causes severe dose- and duration-dependent side effects, but may be superior to prednisone, based on retrospective or uncontrolled studies. Blinded prospecive studies have shown equal efficacy of prednisone and low-dose ACTH, and low versus high-dose ACTH. DESIGN: A prospective, randomized, single-blinded study. SUBJECTS AND METHODS: Patient population consisted of consecutive infants fulfilling entry criteria, including the presence of clinical spasms, hypsarrhythmia (or variants) during a full sleep cycle video-EEG, and no prior steroid/ACTH treatment. Response required both cessation of spasms and elimination of hypsarrhythmia by the end of the 2-week treatment period, as determined by an investigator "blinded" to treatment. Treatment of responders was tapered off over 12 days; those failing one hormone were crossed-over to the other. RESULTS: OF 34 eligible infants, 29 were enrolled. Median age of patients was 6 months. Twenty-two infants were "symptomatic" with known or suspected cause, and seven were cryptogenic (two normal). Of 15 infants randomized to ACTH, 13 responded by EEG and clinical criteria (86.6%); Seizures stopped in an additional infant, but EEG remained hypsarrhythmic (considered a failure). Four of the 14 patients given prednisone responded (28.6%,, with complete clinical-EEG correlation), significantly less than with ACTH, (chi2 test). CONCLUSIONS: Using a prospective, randomized approach, a 2-week course of high-dose ACTH is superior to 2 weeks of prednsone for treatment of IS, as assessed by both clinical and EEG criteria. |
Authors:
|
T Z Baram; W G Mitchell; A Tournay; O C Snead; R A Hanson; E J Horton |
Related Documents
:
|
22273564 - Two-step biochemical differential diagnosis of classic 21-hydroxylase deficiency and cy... 10921974 - Urine d-arabinitol/l-arabinitol ratio in diagnosis of invasive candidiasis in newborn i... 24250734 - The relationship between the first episode of wheezing and matrix metalloproteinases-9 ... 11182674 - Recurrent endogenous candidal endophthalmitis in a premature infant. 16096824 - Gaseous distention of the hypopharynx and cervical esophagus with nasal cpap: a mimicke... 24890394 - How do 9-month-old infants categorize human and ape faces? a rapid repetition erp study. |
Publication Detail:
|
Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
|
Title: Pediatrics Volume: 97 ISSN: 0031-4005 ISO Abbreviation: Pediatrics Publication Date: 1996 Mar |
Date Detail:
|
Created Date: 1996-05-13 Completed Date: 1996-05-13 Revised Date: 2013-06-11 |
Medline Journal Info:
|
Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 375-9 Citation Subset: AIM; IM |
Affiliation:
|
Division of Neurology, Childrens Hospital Los Angeles, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adrenocorticotropic Hormone
/
therapeutic use* Anti-Inflammatory Agents / therapeutic use* Cross-Over Studies Drug Administration Schedule Electroencephalography Female Humans Infant Male Prednisone / therapeutic use* Prospective Studies Single-Blind Method Spasms, Infantile / drug therapy*, etiology Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
|
R01 NS028912-06/NS/NINDS NIH HHS |
| Chemical | |
Reg. No./Substance:
|
0/Anti-Inflammatory Agents; 53-03-2/Prednisone; 9002-60-2/Adrenocorticotropic Hormone |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Radiation exposure from diagnostic radiographs in extremely low birth weight infants.
Next Document: Sweet syndrome associated with G-CSF treatment in a child with glycogen storage disease type Ib.