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-8-02-a 10.15844/pedneurbriefs-8-1-2 Seizure Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Non-Depot ACTH for Infantile Spasms 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 01 1994 01 06 2016 8 1 2 2 Copyright: © 1994 The Author(s) 1994 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. The effect of non-depot ACTH(1-24) on infantile spasms

The effects and side-effects of non-depot ACTH therapy in 18 children with infantile spasms are reported from the Wilhelmina Children’s Hospital, University of Utrecht, The Netherlands.

 Non-Depot ACTH Infantile Spasms Tuberous Sclerosis

The effects and side-effects of non-depot ACTH therapy in 18 children with infantile spasms are reported from the Wilhelmina Children’s Hospital, University of Utrecht, The Netherlands. In i.m. doses of 0.4 mg bid for 4 weeks, followed by gradual withdrawal over 2 weeks, non-depot ACTH resulted in complete control of spasms and normalization of the EEG in 6 (33%) patients, and a partial control in 5. Those with cryptogenic seizures responded whereas infants with congenital defects, excepting 2 with tuberous sclerosis, were refractory to treatment. Response to non-depot ACTH was comparable to that reported for depot ACTH, the incidence of side-effects was lower, and a persistent hypercortisolism was not induced. [1]

COMMENT. Non-depot ACTH appears worthy of further trial in patients with West syndrome. As with depot ACTH, the dosage schedule may require controlled studies to establish optimal efficacy. Dosage based on surface area or body weight would seem more appropriate, if the mechanism of action is related to a direct effect on the brain, as suggested by these authors and by others. The relatively high frequency of serious side-effects sometimes reported with depot ACTH [2] was associated with a high dose regimen(80-140 IU daily for 6 weeks). I have favored the more conservative regimen with smaller, less toxic doses (10-20 IU daily for 2-3 weeks), a treatment schedule also followed in Japan. [3]

 Kusse MC van Nieuwenhuizen O van Huffelen AC van der Mey W Thijssen JH van Ree JM The effect of non-depot ACTH(1-24) on infantile spasms Dev Med Child Neurol 1993 Dec 35 12 1067 1073 10.1111/j.1469-8749.1993.tb07924.x 8253287 Riikonen R Simell O Tuberous sclerosis and infantile spasms Dev Med Child Neurol 1990 Mar 32 3 203 209 10.1111/j.1469-8749.1990.tb16926.x 2155840 Millichap JG Progress in Pediatric Neurology 1991 Chicago PNB Publishers 25 26 30-34