Clinical Value Of Continuous EEG Monitoring After ACTH For Infantile Spasm

Objective:to summarize the curative effect of adrenocorticotropic hormone(ACTH)in the treatment of infantile spasm(IS),and explore the clinical value of regular video-electroencephalography(VEEG)monitoring in evaluating the prognosis of IS.Methods:seventy-seven children with IS diagnosed and treated in the Department of Pediatrics in Handan Central Hospital from January 2017 to January2019 were selected as subjects.All children were given intravenous infusion of ACTH,4-h VEEG was monitored after treatment,and the curative effect was evaluated after two weeks of treatment,and the changes in spasms and EEG before and after treatment were compared.The long-term spasm,EEG recovery and intellectual and motor development of the children were investigated by outpatient follow-up or return visit via telephone,and the prognosis of the children was evaluated.Results:After two weeks of treatment,the effective rates of spasm control and EEG recovery were 67.53%and 61.04%respectively.The effective rates of EEG recovery and spasm control in children with IS induced by unknown causes were higher than that in the structural/metabolic group,and the difference was statistically significant(?~2=19.026,?~2=21.554,all P<0.001,table 3-1,table 3-2).No statistically significant differences were found in the effective rate of spasm control and EEG recovery among the patients with different ages of onset or courses of disease,(All P>0.05,table 3-1,table 3-2).Spasm control was positively correlated with the hypsarrhythmia in the EEG to some extent(r=0.473,P<0.05,table 3-3).The effective rates of spasm control and EEG recovery(3,6 and 12 months)after treatment presented no statistically significant differences from those after two weeks of treatment(all P>0.05,table 3-4,table 3-5).The effective rate of spasm control was positively correlated with the sustaining hypsarrhythmia in the EEG(3,6 and 12months)after treatment(r=0.328,0.443,0.451,P=0.019,0.005,0.004,table 3-8).Significant differences are found in effects of etiology,spasm onset,spasm recurrence,hypsarrhythmia or abnormal discharge in the EEG on long-term prognosis(all P<0.05,table 3-10).Conclusions:No significant difference is found between short-term and long-term curative effect of ACTH.Spasm control is positively correlated with the hypsarrhythmia in the EEG to some extent.Recurrence of spasm is positively correlated with the sustaining hypsarrhythmia in the EEG.Unknown cause,no recurrence of spasm,spasm control,return to normal EEG,the prognosis of the child patient is relatively good.Regular VEEG monitoring is of great value in the early diagnosis,evaluation of curative effect after treatment,prediction of recurrence,monitoring of cognitive function and prognosis evaluation.