Abstract
Objective
To compare the outcomes of adrenocorticotrophic hormone (ACTH) and Prednisolone therapy in children with West syndrome.
Methods
The study was done at a tertiary health centre for children. The pediatric neurologist at the centre enrolled children into the study based on the inclusion and exclusion criteria. They were evaluated in detail, classified according to etiologic type and then, randomly assigned into two treatment groups, either ACTH or Prednisolone. They were followed at regular intervals till 6 mo.
Results
There was no difference between ACTH and Prednisolone groups with respect to all the outcomes measured. Cessation of spasms was achieved in 6/15 (40%) in Prednisolone group and 9/18 (50%) in ACTH group (p = 0.3906). The average time for achieving cessation was 6.9 and 8 d in ACTH and Prednisolone groups respectively (p = 0.7902). The relapse rates were 18.18 and 50% in ACTH and Prednisolone groups respectively (p = 0.28). The side-effects profile, subsequent epilepsy rates and improvement in milestones were similar in both the treatment groups.
Conclusions
There is no significant difference in children treated with ACTH and Prednisolone. Study results cannot be generalized due to small sample size. However, Prednisolone can be a suitable alternative to ACTH in resource poor settings.
Similar content being viewed by others
References
Dulac O. Review article – what is West syndrome? Brain Dev J. 2001;23:447–52.
Riikonen R. Long-term evolution of epileptic encephalopathies. In: Marina N, Pierre G, Anne S, editors. West syndrome. John Libbey Eurotext; 2009. p. 13–28. (Topics in Epilepsy series, Vol 1). [Internet] Available at: https://books.google.co.in/books?id=xMc63-y4afAC. Accessed 4 Oct 2015.
Lux AL. Review article – West & son: the origins of West syndrome. Brain Dev J. 2001;23:443–6.
Eling P, Renier WO, Pomper J, Baram TZ. The mystery of the Doctor’s son, or the riddle of West syndrome. Neurology. 2002;58:953–5.
Pies NJ, Beardsmore CW. West & West syndrome – a historical sketch about the eponymous doctor, his work and his family. Brain Dev J. 2003;25:84–101.
Shorvon SD. The etiologic classification of epilepsy. Epilepsia. 2011;52:1052–7.
Pellock JM, Hrachovy R, Shinnar S, et al. Infantile spasms: a U.S. consensus report. Epilepsia. 2010;51:2175–89.
Osborne JP, Lux AL, Edwards SW, et al. The underlying etiology of infantile spasms (west syndrome): information from the United Kingdom infantile spasms study (UKISS) on contemporary causes and their classification. Epilepsia. 2010;51:2168–74.
Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsy: report of the ILAE commission on classification and terminology, 2005-2009. Epilepsia. 2010;51:676–85.
Baram TZ. Pathophysiology of massive infantile spasms: perspective on the putative role of the brain adrenal axis. Ann Neurol. 1993;33:231–6.
Insel TR, Battaglia G, Fairbanks DW, De Souza EB. The ontogeny of brain receptors for corticotrophin-releasing factor and the development of their functional association with adenylate cyclase. J Neurosci. 1988;8:4151–8.
Marrosu F, Fratta W, Carcangiu P, Giagheddu M, Gessa GL. Localized epileptiform activity induced by murine CRF in rats. Epilepsia. 1988;29:369–73.
Baram TZ, Hirsch E, Snead OC III, Schultz L. CRH induced seizures in the infant brain originate in the amygdala. Ann Neurol. 1992;31:488–94.
Jingami H, Matsukura S, Numa S, Imura H. Effects of adrenalectomy and dexamethasone administration on the level of pre pro corticotrophin releasing factor messenger-RNA in the hypothalamus and adrenocorticotrophin/beta-lipotropin precursor mRNA in the pituitary in rats. Endocrinology. 1985;117:1314–20.
Joels M, de Kloet ER. Control of neuronal excitability by corticosteroid hormones. Trends Neurosci. 1992;15:25–9.
Vaddi VK, Sahu JK, Dhawan SR, Suthar R, Sankhyan N. Knowledge, attitude and practice (KAP) study of pediatricians on infantile spasms. Indian J Pediatr. 2018. https://doi.org/10.1007/s12098-018-2630-3.
Kliegman R, Behrman RE, Nelson WE. The nervous system. In: Kliegman R, Behrman RE, Nelson WE, editors. Nelson textbook of pediatrics, vol. 2. 20th ed. Phialdelphia: Elsevier; 2016. p. 2840–1.
Sahu JK. Infantile spasms – evidence based medical management. Indian J Pediatr. 2014;81:1052–5.
Lux AL, Osborne JP. A proposal for case definitions and outcome measures in studies of infantile spasms and west syndrome: consensus statement of the West Delphi group. Epilepsia. 2004;45:1416–28.
Baram TZ, Mitchell WG, Tournay A, Snead OC, Hanson RA, Horton EJ. High dose corticotrophin (ACTH) versus prednisone for infantile spasms: a prospective, randomized, blinded study. Pediatrics. 1996;97:375–9.
Hrachovy RA, Frost JD, Kellaway R, Zion TE. Double blind study of ACTH vs. prednisone therapy in infantile spasms. J Pediatr. 1983;103:641–5.
Hrachovy RA, Frost JD Jr, Glaze DG. High-dose, long-duration versus low-dose, short-duration corticotropin therapy for infantile spasms. J Pediatr. 1994;124:803–6.
Azam M, Bhatti N, Krishin J. Use of ACTH and prednisolone in infantile spasms: experience from a developing country. Seizure. 2005;14:552–6.
Kossoff EH, Hartman AL, Rubenstein JE, Vining EP. High dose prednisolone for infantile spasms: an effective and less expensive alternative to ACTH. Epilepsy Behav. 2009;14:674–6.
Kalra V, Gulati S, Pandey RM, Menon S. West syndrome and other epileptic encephalopathies – Indian hospital experience. Brain Dev. 2002;24:130–9.
Snead OC III, Benton JW, Myers GJ. ACTH and prednisone in childhood seizure disorders. Neurology. 1983;33:966–70.
Wanigasinghe J, Phila M, Arambepola C, Ranganathan SS, Sumanasena S, Attanapola G. Randomized, single-blind, parallel clinical trial on efficacy of oral prednisolone versus intramuscular corticotrophin on immediate and continued spasm control in West syndrome. Pediatr Neurol. 2015;53:193–9.
Author information
Authors and Affiliations
Contributions
VKG: Concept and designed the study; VN: Collected the data and helped in data analysis; SKS: Analyzed the data and drafted the manuscript; NB: Concept of study and supervised seizure control; AB: Edited and refined the draft. VKG will act as guarantor for this paper.
Corresponding author
Ethics declarations
Conflict of Interest
None.
Rights and permissions
About this article
Cite this article
Gowda, V.K., Narayanaswamy, V., Shivappa, S.K. et al. Corticotrophin-ACTH in Comparison to Prednisolone in West Syndrome – A Randomized Study. Indian J Pediatr 86, 165–170 (2019). https://doi.org/10.1007/s12098-018-2782-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-018-2782-1