HIGH-DOSE, LONG-DURATION VERSUS LOW-DOSE, SHORT-DURATION CORTICOTROPIN THERAPY FOR INFANTILE SPASMS

Fifty patients in whom the diagnosis of infantile spasms had recently been made and who had hypsarrhythmic electroencephalographic findings were randomly assigned to receive either high- or low-dose therapy wit h corticotropin (adrenocorticotropic hormone; ACTH). Twenty-six patien ts receiving the high-dose therapy were treated as follows: 150 U/m(2) per day for 3 weeks, 80 U/m(2) per day for 2 weeks, 80 U/m(2) every o ther day for 3 weeks, and 50 U/m(2) per day every other day for 1 week , with the dosage then tapered to zero during a 3-week period. The 24 patients assigned to the low-dose therapy group received 20 to 30 U/da y for 2 to 6 weeks; the dosage was then tapered to zero during a 1-wee k period. Population characteristics (cryptogenic vs symptomatic, trea tment lag, and age at start of treatment) of the two groups were simil ar. Response, defined as cessation of spasms and disappearance of hyps arrhythmia, was determined objectively by serial prolonged video and p olygraphic monitoring studies. Of the 26 patients treated with the hig h-dose therapy, 13 (50%) responded; of the 24 patients treated with th e low-dose therapy, 14 (58%) responded (p value not significant). No s ignificant difference in the relapse rate between the two groups was o bserved. The side effects seen in both treatment groups were similar, except that hypertension occurred more frequently in the high-dose gro up. These results indicate that there is no major difference in the ef fectiveness of these two regimens in the treatment of infantile spasms with respect to spasm cessation and improvement in the patients' elec troencephalographic findings.