Skip to main content

Advertisement

Log in

Corticotrophin-ACTH in Comparison to Prednisolone in West Syndrome – A Randomized Study

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dulac O. Review article – what is West syndrome? Brain Dev J. 2001;23:447–52.

    Article  CAS  Google Scholar 

  2. 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.

  3. Lux AL. Review article – West & son: the origins of West syndrome. Brain Dev J. 2001;23:443–6.

    Article  CAS  Google Scholar 

  4. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  6. Shorvon SD. The etiologic classification of epilepsy. Epilepsia. 2011;52:1052–7.

    Article  PubMed  Google Scholar 

  7. Pellock JM, Hrachovy R, Shinnar S, et al. Infantile spasms: a U.S. consensus report. Epilepsia. 2010;51:2175–89.

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

  10. Baram TZ. Pathophysiology of massive infantile spasms: perspective on the putative role of the brain adrenal axis. Ann Neurol. 1993;33:231–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  CAS  PubMed  Google Scholar 

  12. Marrosu F, Fratta W, Carcangiu P, Giagheddu M, Gessa GL. Localized epileptiform activity induced by murine CRF in rats. Epilepsia. 1988;29:369–73.

    Article  CAS  PubMed  Google Scholar 

  13. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  CAS  PubMed  Google Scholar 

  15. Joels M, de Kloet ER. Control of neuronal excitability by corticosteroid hormones. Trends Neurosci. 1992;15:25–9.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

  17. 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.

    Google Scholar 

  18. Sahu JK. Infantile spasms – evidence based medical management. Indian J Pediatr. 2014;81:1052–5.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. 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.

    Article  CAS  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. Azam M, Bhatti N, Krishin J. Use of ACTH and prednisolone in infantile spasms: experience from a developing country. Seizure. 2005;14:552–6.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Kalra V, Gulati S, Pandey RM, Menon S. West syndrome and other epileptic encephalopathies – Indian hospital experience. Brain Dev. 2002;24:130–9.

    Article  PubMed  Google Scholar 

  26. Snead OC III, Benton JW, Myers GJ. ACTH and prednisone in childhood seizure disorders. Neurology. 1983;33:966–70.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

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

Correspondence to Vykuntaraju K. Gowda.

Ethics declarations

Conflict of Interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-018-2782-1

Keywords

Navigation