Thyrotropin-releasing hormone: role in the treatment of West syndrome and related epileptic encephalopathies

Thyrotropin-releasing hormone (TRH) has been successfully used for treating children with neurologic disorders including epilepsy. The effectiveness o f TRH and a TRH analog has been reported in West syndrome, Lennox-Gastaut s yndrome, and early infantile epileptic encephalopathy that were intractable to anticonvulsants and adrenocorticotrophic hormone (ACTH). However, the p eptide has not been widely studied as a treatment of intractable epilepsy o utside Japan. TRH is safe in children and effective in sonic cases of West syndrome and Lennox-Gastaut syndrome. TRH is considered as a possible new s trategy for treating West syndrome and Lennox-Gastaut syndrome prior to ACT H therapy, especially for the patient with an infection, immunosuppression, or severe organic lesions in the brain. The mechanisms of its antiepilepti c action may differ from those of other antiepileptic drugs. One possibilit y is that TRH may act as an antiepileptic through a kynurenine mechanism, c onsidering that kynurenic acid acts as an antagonist on the N-methyl-D-aspa rtate receptor complex. (C) 2001 Elsevier Science B.V. All rights reserved.