Clinical Study Of Augmentation Of ACTH In The Treatment Of Infantile Spasms

Objective : To evaluate the efficacy and safety of short-course escalation of adrenal cortical hormone(ACTH)in the treatment of infantile spasm(IS)by retrospective study.Methods : The clinical data of 40 children with IS who underwent ACTH in the Department of Neurology,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine from January 2016 to January 2018 were collected and retrospectively analyzed.All children were treated with intravenous infusion of ACTH dose-increasing treatment: the initial dose was 12.5 U/d for 3 days,and if the seizure did not disappear,the amount was increased to 25 U/d for 3 days.If the sputum still could not be fully controlled,the dosage was increased.Continue to apply to 40U/d,the total course of treatment is no more than 2 weeks;the rate of seizures disappears in each dose stage or when the course of treatment reaches 2 weeks,it is changed to prednisone 2mg/(kg·d)orally,and gradually decreases to within 2 months.medicine.All children underwent EEG examination before and after treatment.Results: Of the 40 patients,17 were female and 23 were male.The age of onset was between 8 days and 20 months,38 cases(95%)were within 1 year of age,and the peak age of onset was from 2 months to 7 months,a total of 30 cases(75%).All patients had seizure patterns,flexion type: 18 cases(45%),extension type: 16 cases(40%),and mixed type 6 cases(15%).The electroencephalogram of 40 patients in this group were abnormal,including 24 cases(60%)with typical height loss syndrome,12cases(30%)with variable height loss,and 4 cases(burst suppression,multiple spikes,etc.).(10%).Among the 40 children with IS: 32 cases(80%)with symptomatic IS and8 cases(20%)with cryptogenic IS.There were 4 cases of mental retardation at the onset of illness.Forty patients with IS were treated with the ACTH dose escalationregimen.The rate of sputum seizures was 40%(16/40),7.5%(3/40)at 12.5 U/d,and16.2% at 25 U/d(6/ 37),22.6%(7/31)at 40 U/d;the overall rate of disappearance of EEG is 60%(24/40),and each dose stage is 5%(2/40),10.8%(4 /37)and 58.1%(18/31).37.5%(15/40)of the children had mild adverse reactions,mainly respiratory infections.Conclusion : The short-term control rate of IS in the treatment of IS in this program has reached the effective rate of ACTH reported in the literature,and the side effects are small.