Main Article Content

Abstract

 Objective: To compare the outcome of ACTH with oral prednisolone for treatment of infantile spasms.


Methodology: This is a randomized controlled trial conducted at department of paediatric neurology, The Children Hospital, Lahore, Pakistan after ethical approval from January 1st 2014 to December 31st 2017. (Four years). Seventy patients with infantile spasms were randomized in two equal groups of 35 patients in each group. Patients in group A received prednisolone and in group B received ACTH. The two groups were compared for the spasms free period.  Statistical significant determined by chi-square test (p< 0.05 was taken as significant). Non-probability purposive sampling was used and an inclusion criterion was children up to age of one year with infantile spasms. Exclusion criteria include children who had been previously treated with steroids or ACTH. Seventy patients fulfilling inclusion criteria were enrolled through neurology department of Children Hospital, Lahore. History, informed consent was taken by parents and was divided in two groups by lottery method. All the information was collected on a specially designed proforma.


Results: In group A, 29 (83%) patients were spasms free, while in group B, 31 (88%) patients were spasms free.


Conclusion: Significant number of patients with IS were spasms free with prednisolone which is very cost effective drug as compared to ACTH. Developing counties should considered this treatment option as a first line therapy.


Key words: Epilepsy, ACTH, Prednisolone, Infantile spasms, Hypsarthymia.

Keywords

epilepsy infantile spasms adrenocorticotropic hormone prednisolone hypsarrhythmia randomized controlled trial

Article Details

Author Biography

Tipu Sultan, Institute of Child health & Children's Hospital, Lahore, Pakistan

Head of child Neurology Department
The Children Hospital & Institute of Child Health, Lahore
PAKISTAN

How to Cite
Sardar, H., Khan, A. A., & Sultan, T. (2020). Treatment of infantile spasms in resource limited settings: Arandomized controlled trial. Journal of the International Child Neurology Association, 1(1). https://doi.org/10.17724/jicna.2019.163

References

  1. Workshop on Infantile Spasms. (1992). Epilepsia, 33(1), 195–195. https://doi.org/10.1111/j.1528-1157.1992.tb02306.x
  2. Azam, M., Bhatti, N., & Krishin, J. (2005). Use of ACTH and prednisolone in infantile spasms: Experience from a developing country. Seizure, 14(8), 552–556. https://doi.org/10.1016/j.seizure.2005.08.009
  3. Baram, T. Z., Mitchell, W. G., Tournay, A., Snead, O. C., Hanson, R. A., & Horton, E. J. (1996). High-dose corticotropin (ACTH) versus prednisone for infantile spasms: a prospective, randomized, blinded study. Pediatrics, 97(3), 375–379. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8604274
  4. Bonkowsky, J. L., Filloux, F. M., & Byington, C. L. (2006). Herpes simplex virus central nervous system relapse during treatment of infantile spasms with corticotropin. Pediatrics, 117(5), e1045-8. https://doi.org/10.1542/peds.2005-1867
  5. Carmant, L. (2011). Vigabatrin therapy for infantile spasms: review of major trials in Europe, Canada, and the United States; and recommendations for dosing. Acta Neurologica Scandinavica. Supplementum, (192), 36–47. https://doi.org/10.1111/j.1600-0404.2011.01599.x
  6. Gupta, R., & Appleton, R. (2005). Corticosteroids in the management of the paediatric epilepsies. Archives of Disease in Childhood, 90(4), 379–384. https://doi.org/10.1136/adc.2004.051375
  7. Hrachovy RA, F. J. (2008). Severe encephalopathic epilepsy in infants: infantile spasmss (West syndrome). In S. R. Pellock JM, Bourgeois BF, Dodson WE, Nordli DR Jr (Ed.), Pediatric Epilepsy: Diagnosis and Therapy (pp. 249–268). New York, NY: Demos Medical Publishing.
  8. Ibrahim, S., Gulab, S., Ishaque, S., & Saleem, T. (2010). Clinical profile and treatment of infantile spasms using vigabatrin and ACTH--a developing country perspective. BMC Pediatrics, 10, 1. https://doi.org/10.1186/1471-2431-10-1
  9. J. Piña-Garza. (2013). Fenichel’s Clinical Pediatric Neurology (7th Editio). Saunders Elsevier.
  10. Johnston MV. (2007). Infantile spasms. In S. B. Behrman RE, Kliegman RM, Jenson HB (Ed.), Nelson text book of paediatrics. (pp. 2463–2464). W. B. Saunders.
  11. Kossoff, E. H., Hartman, A. L., Rubenstein, J. E., & Vining, E. P. G. (2009). High-dose oral prednisolone for infantile spasms: an effective and less expensive alternative to ACTH. Epilepsy & Behavior : E&B, 14(4), 674–676. https://doi.org/10.1016/j.yebeh.2009.01.023
  12. Lerner, J. T., Salamon, N., & Sankar, R. (2010). Clinical profile of vigabatrin as monotherapy for treatment of infantile spasms. Neuropsychiatric Disease and Treatment, 6, 731–740. https://doi.org/10.2147/NDT.S5235
  13. Noureen, N., & Rana, M. T. (2010). Clinical profile and response to oral prednisolone in infantile spasm. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 20(3), 186–189. https://doi.org/03.2010/JCPSP.112116
  14. Pellock, J. M., Hrachovy, R., Shinnar, S., Baram, T. Z., Bettis, D., Dlugos, D. J., … Wheless, J. W. (2010). Infantile spasms: a U.S. consensus report. Epilepsia, 51(10), 2175–2189. https://doi.org/10.1111/j.1528-1167.2010.02657.x
  15. Riikonen, R. (2001). Epidemiological data of West syndrome in Finland. Brain & Development, 23(7), 539–541. https://doi.org/10.1016/s0387-7604(01)00263-7
  16. Sankar R, Koh S, Wu J, Menkes JH. . In: Menkes JH, Sernat HB, M. B. (Ed.). (2006). Infantile spasms (West syndrome). In Child neurology (7th ed, pp. 877–880). Philadelphia: Lippincott Williams & Wilkins.
  17. Shields, W. D. (n.d.). Infantile spasms: little seizures, BIG consequences. Epilepsy Currents, 6(3), 63–69. https://doi.org/10.1111/j.1535-7511.2006.00100.x
  18. Stafstrom, C. E., & Holmes, G. L. (2007). Can preventative antiepileptic therapy alter outcome in infants with tuberous sclerosis complex? Epilepsia, 48(8), 1632–1634. https://doi.org/10.1111/j.1528-1167.2007.01178_4.x
  19. Tsao, C.-Y. (2009). Current trends in the treatment of infantile spasms. Neuropsychiatric Disease and Treatment, 5, 289–299. https://doi.org/10.2147/ndt.s4488
  20. Vinters, H. V. (2002). Histopathology of brain tissue from patients with infantile spasms. International Review of Neurobiology, 49, 63–76. https://doi.org/10.1016/s0074-7742(02)49007-1
  21. Wanigasinghe, J. (2010). Diagnosis and treatment of infantile spasms. Sri Lanka Journal of Child Health, 39(4), 141. https://doi.org/10.4038/sljch.v39i4.2480