The Study Of The Efficacy Of Different Doses Adrenocorticotrophic Hormone And Monosialoganglioside Therapy For Infantile Spasms

ObjectiveTo compare the efficacy and adverse effects of conventional dose and low dose adrenocorticotrophic hormone(ACTH) therapy for Infantile spasms(IS) and to investigate the efficacy of monosialoganglioside combined antiepileptic drug in the clinical treatment of infantile spasms.MethodsA retrospective study was conducted.Patients with infantile spasms were divided into 4 groups, respectively, conventional dose ATCH group (n= 32) and small dose ACTH group (n= 37), only the application of anti-epileptic drug treatment group (n= 30) and anti-epileptic drugs combined with monosialoganglioside treatment group (n= 29).For the conventional dose group,ACTH 25IU per day was injected,after seizures were fully controlled, ACTH was continued to be injected for the next 2 weeks.The total course of treatment is not more than 4 weeks, then changed to prednisone to continue treatment. For the low dose group,ACTH 1IU/kg per day was injected,after seizures were fully controlled, ACTH was continued to be injected for the next 2 weeks.The total course of treatment is not more than 4 weeks, Then changed to prednisone to continue treatment.Both effectiveness and adverse effects were compared between the two groups. Make 30 cases which application of anti-epileptic drug therapy only as control group, while 29 cases which were combined with monosialoganglioside as treatment group, combined with monosialoganglioside treatment group were injected monosialoganglioside 20mg/d for 10 days continuously every 4 weeks, totally 6 courses of treatment, the therapeutic effects of 4 weeks and 12 months after treatment between the two groups were compared.ResultsThe were no significant differences in the good initial responses between the conventional and low dose groups,which were 78.2%and 73.0%Respectively (P>0.05).The time of spasms completely controlled after ACTH therapy were no significant differences between the two groups(P>0.05).The long-term outcomes were assessed in the initial 45 responders, there were no significant differences between the two groups(P>0.05).The incidence of ACTH therapy related-adverse effects in the conventional dose group(90.6%)was significantly higher than in the low dose group(24.3%)(P<0.01). There were no statistical differences in the time and the rate that spasms were completely controlled between the anti-epileptic drugs combined with monosialoganglioside treatment group and the control group 4 weeks after treatment(P>0.05),and there were no statistical differences in the rate of no spasms between the two groups 12 months after treatment(P>0.05)ConclusionsThe short-term and long-term therapeutic effects of ACTH between 25IU/d and 1IU/(kg.d)doses are similar.In order to reduce adverse effects,ACTH therapy should start with a low dose(1IU/kg each day). There were no statistical differences in the prognosis of infantile spasms between the anti-epileptic drugs combined with monosialoganglioside treatment group and the control group,we should collect more cases to observe the therapeutic effects of Monosialoganglioside combined antiepileptic drug therapy for infantile spasms in the future.