Corticotrophin-ACTH in Comparison to Prednisolone in West Syndrome – A Randomized Study
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To compare the outcomes of adrenocorticotrophic hormone (ACTH) and Prednisolone therapy in children with West syndrome.
The study was done at a tertiary health centre for children. The pediatric neurologist at the centre enrolled children into the study based on the inclusion and exclusion criteria. They were evaluated in detail, classified according to etiologic type and then, randomly assigned into two treatment groups, either ACTH or Prednisolone. They were followed at regular intervals till 6 mo.
There was no difference between ACTH and Prednisolone groups with respect to all the outcomes measured. Cessation of spasms was achieved in 6/15 (40%) in Prednisolone group and 9/18 (50%) in ACTH group (p = 0.3906). The average time for achieving cessation was 6.9 and 8 d in ACTH and Prednisolone groups respectively (p = 0.7902). The relapse rates were 18.18 and 50% in ACTH and Prednisolone groups respectively (p = 0.28). The side-effects profile, subsequent epilepsy rates and improvement in milestones were similar in both the treatment groups.
There is no significant difference in children treated with ACTH and Prednisolone. Study results cannot be generalized due to small sample size. However, Prednisolone can be a suitable alternative to ACTH in resource poor settings.
KeywordsACTH Prednisolone West syndrome Infantile spasms
VKG: Concept and designed the study; VN: Collected the data and helped in data analysis; SKS: Analyzed the data and drafted the manuscript; NB: Concept of study and supervised seizure control; AB: Edited and refined the draft. VKG will act as guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest
- 2.Riikonen R. Long-term evolution of epileptic encephalopathies. In: Marina N, Pierre G, Anne S, editors. West syndrome. John Libbey Eurotext; 2009. p. 13–28. (Topics in Epilepsy series, Vol 1). [Internet] Available at: https://books.google.co.in/books?id=xMc63-y4afAC. Accessed 4 Oct 2015.
- 14.Jingami H, Matsukura S, Numa S, Imura H. Effects of adrenalectomy and dexamethasone administration on the level of pre pro corticotrophin releasing factor messenger-RNA in the hypothalamus and adrenocorticotrophin/beta-lipotropin precursor mRNA in the pituitary in rats. Endocrinology. 1985;117:1314–20.CrossRefGoogle Scholar
- 16.Vaddi VK, Sahu JK, Dhawan SR, Suthar R, Sankhyan N. Knowledge, attitude and practice (KAP) study of pediatricians on infantile spasms. Indian J Pediatr. 2018. https://doi.org/10.1007/s12098-018-2630-3.
- 17.Kliegman R, Behrman RE, Nelson WE. The nervous system. In: Kliegman R, Behrman RE, Nelson WE, editors. Nelson textbook of pediatrics, vol. 2. 20th ed. Phialdelphia: Elsevier; 2016. p. 2840–1.Google Scholar
- 27.Wanigasinghe J, Phila M, Arambepola C, Ranganathan SS, Sumanasena S, Attanapola G. Randomized, single-blind, parallel clinical trial on efficacy of oral prednisolone versus intramuscular corticotrophin on immediate and continued spasm control in West syndrome. Pediatr Neurol. 2015;53:193–9.CrossRefGoogle Scholar