Clinical Effect And Aeeg Changes About Low-Dosage ACTH And Nitrazepam To Treat West Syndrome

Objiectives;Infantile spasms(West syndrome)is a severe age-dependent intractable epilepsy that frequently results in mental retardation.The exact pathophysiology still remains unknown,the prognosis is worse.Nowdays it is now empirical treatment.We adopt short-during low-dosage ACTH with Nitrazepam to treating West syndrome,inorder to observe clincical effect,study EEG changes before and after treatment,and side-effects,and so on.Methods;From January 2003 to October 2006,92 children with West syndrome were collected as subjectives,Which must be untreated.The patients were classifed at random into treatment group(62 cases)and control group(30 cases),At the same time in treatment group according to etiology,divided into two groups;treatment group A(symptomatic 40 cases)and treatment group B(cryptogentic 22 cases).There were 56 male and 36 female children,Whose age ranged from 2 months to 18 months,90% children's age were less than 12 months.The disease peak age was 4 to 6 months.In diffent series the frequency of 3 types were 71.7%flexor,10.9%extensor and 19.4%mixed.All patients were checked by AEEG and other examination before treatment.Children of the treatment group A and B received intravenous ACTH (which less one year old received 10Iu/day,over one year old received 15Iu/day)and oral Nitrazepam 0.2mg/kg/day,used continously for 15 days.Control group received oral prednisone 2mg/kg/day and oral Nitrazepam 0.2mg/kg/day for 15 days.After treatment in all patients underwent ambulatory EEG examination,the location,the frequency and the morphology of epileptic discharges.We observed the changes and compared with that of pretreatment one.All patients were measured blood pressure twice every day and tested blood indicators,electrolytes,electrocardiogram,which results be contrasted before and after trcatment.Then we observed their side-effects.Results;1,There was no signficant difference on spasm seizure and epileptic discharges of EEG between treatment group with the control group before treatment, (P＞0.05).2,There was signficant difference between the treatment group and control group on spasmus control and AEEG changes after treatment,(P＜0.05).3,There was signficant difference between group A(symptomatic)and the treatment group B(cryptogentic)on spasmus control and EEG changes after treatment,(P＜0.05 or P＜0.01).4,There was no signficant difference of treatment group on blood pressure,electrolytes and ECG,(P＞0.05).5,24-hours recording demonstrated that the pattern of EEG modified dramatidally,the patterns of EEG in wake,sleep, on set and interictal were different.We could discove more pattern of modified hypsarrhythria.It was advantageous to diagnose.6,Before treatment about AEEG, hypsarrhythmia showed in sleep in major,60%occured at waken time,80%occured at NREMⅡperiod,95%took place at NREMⅡtoⅣperiod,more less at REM period.7,90%hypsarrhythmia of treatment group disappeared after treatment,whereas 40%disappeared of control group.Conclusions; 1,It is effective and fewer side-effects to treat West syndrome with low-dose ACTH.2,It is more effective for cryptogenic than symptomatic West syndrome.3,ACTH therapy to West syndrome is more effective than oral steriod therapy.4,AEEG changed obviously for ACTH to treat West syndrome and hypsarrhythmia disppeared quickly.5,low-doseage ACTH and nitrazepan to treat West syndrome were effective and secure.