[Clinical efficacy of shortened ACTH therapy --an individualized method for minimization of adverse effects--Part 1. The short-term outcome].

Abstract

To minimize adverse effects and to get good efficacy of ACTH therapy against West syndrome, we tried a new 2-steps therapeutic protocol consisting of the shortened ACTH therapy and the additional ACTH therapy. In a prospective multi-institutional study, 20 patients with newly diagnosed West syndrome who had failed to respond to high-dose vitamin B6 and zonisamide were treated by this shortened ACTH therapy. Synthetic corticotropin (ACTH-Z 0.025 mg/kg/dose, max 0.25 mg) was administrated intramuscularly seven times on every other day for 14 days. At 1 month after discontinuing corticotropin, spasms and hypsarrhythmia disappeared in 10/20 (50%) and 13/17 (59%) patients respectively. Subsequently, 9 out of the 10 patients with persistent spasms received additional therapy for 1 or 2 weeks with daily intramuscular ACTH-Z, which was tapered off over a few weeks. Including the additional ACTH therapy, the disappearance of spasms and hypsarrhythmia were found in 13 patients (65%) and 13 patients (76%). Adverse effects during the shortened ACTH therapy were fewer than additional ACTH therapy but not statistically significant. Severe adverse effects were not observed in both ACTH therapy. In the 2-steps therapeutic protocol according to the response to ACTH, favorable results were obtained in seizure control, EEG findings and the degree of adverse effects.

• Authors: Hitoshi Ueda, Katsumi Imai, Yasuhisa Toribe, Toshiyuki Mano, Taro Matsuoka, Yasuhiro Fujikawa, Tetsuzo Tagawa, Yoshiki Morita, Jiro Abe, Toshisaburo Nagai
• Journal: No to hattatsu = Brain and development (No To Hattatsu) Vol. 37 Issue 1 Pg. 46-53 (Jan 2005) ISSN: 0029-0831 [Print] Japan
• PMID: 15675359 (Publication Type: Clinical Trial, English Abstract, Journal Article, Multicenter Study)

Chemical References

• Adrenocorticotropic Hormone

Topics

• Adrenocorticotropic Hormone (administration & dosage, adverse effects)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Electroencephalography
• Humans
• Infant
• Prospective Studies
• Spasms, Infantile (drug therapy, physiopathology)
• Treatment Outcome