ADRENOCORTICOTROPIC HORMONE AND VIGABATRIN TREATMENT OF CHILDREN WITHINFANTILE SPASMS UNDERLYING CEREBRAL-PALSY

Nine infants with an underlying static encephalopathy (confirmed as ce rebral palsy in a later follow-up examination) and newly diagnosed inf antile spasms were entered in an open study with adrenocorticotropic h ormone (ACTH) and vigabatrin as the initial therapy regimen. The ACTH was discontinued after 4-6 weeks and the infants were maintained on vi gabatrin alone. Following an initial response with complete suppressio n of spasms in all patients, a long term response maintained for a mea n of 19.2 months was confirmed in all but one child. Tolerability appe ared excellent with 7 of 9 patients reporting no side effects; vigabat rin related hypotonia presented in all patients and turned out to be a 'positive' side-effect on the abnormally increased muscle tone of the se infants. Given the very poor prognosis of infantile spasms especial ly in such conditions as cerebral palsy, the combination of ACTH and v igabatrin appears to be an interesting therapy advance with very few s ide effects.