1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-1-46 10.15844/pedneurbriefs-1-6-11 Paroxysmal Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Infantile Spasms and ACTH Dosage http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 11 1987 01 08 2016 1 6 46 46 Copyright: © 1987 The Author(s) 1987 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Further observations on the treatment of infantile spasms with corticotropin

Results of corticotropin treatment of 33 patients with infantile spasms are reported from the Instituto Clinica Pediatrica, Universita di Siena, Italy.

 Idiopathic Cases Longer Periods Perinatal Distress

Results of corticotropin treatment of 33 patients with infantile spasms are reported from the Instituto Clinica Pediatrica, Universita di Siena, Italy. The etiology was undetermined in 8 and secondary in 25 (pre- or perinatal distress in 17 and tuberous sclerosis in 2). Pyridoxine 300mg IV tried in all cases initially with EEG monitoring was without effect. ACTH 2 units/kg daily for 10 days followed by alternate day treatment for 10 days with a repeat course in some resulted in improvement in all idiopathic cases (complete in 6) and in 15 secondary cases (complete only in 2). The authors advocate low doses and short courses of ACTH, claiming results comparable with larger amounts (up to 10-12 u/kg/day) for longer periods (3 mos) employed by some. Ibid, Eur J Pediatr 1983;42:51. [1]

COMMENT. The mechanism of the anticonvulsant action of ACTH in infantile spasms is unknown. It is probably independent of the adrenal [2] and a possible direct CNS effect is a reason proposed for the use of high dosage schedules. In agreement with the present study, my own results with smaller doses, 10-20 units daily irrespective of body weight for 20 days, have equalled those reported with higher doses and longer courses, and serious side effects have been avoided.

 Fois A Malandrini F Mostardini R Further observations on the treatment of infantile spasms with corticotropin Brain Dev 1987 9 2 82 4 2820258 10.1016/S0387-7604(87)80022-0 Wasserman MJ Belton NR Millichap JG Effect of corticotropin (ACTH) on experimental seizures Adrenal independence and relation to intracellular brain sodium. Neurology 1965 Dec 15 12 1136 41 4286107 10.1212/WNL.15.12.1136