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Synthetic adrenocorticotropic hormone for Epileptic Spasms: A Follow up Study in Zhonghe Dist., New Taipei City, Taiwan

Background Several studies had reported that the clinical response to ACTH therapy in 42-87% of patients within two weeks occurred without major adverse side effects, but relapse rate is high from 30% to 72%.

Methods Retrospectively from 2008 to 2018, we reviewed the charts of total fifteen infants diagnosed as epileptic spasms to study and analyze the outcomes of short-term (within eight weeks’ therapy) and long-term (two years after ACTH therapy).

Results Thirteen enrolled infants, all term birth, were divided into two groups. Four infants were classified as cryptogenic group (CRY). Nine infants were classified as symptomatic group (SYM) due to various perinatal insults and underlying diseases. The followings are observed: - sex: male 69% > female 31% - seizure reduced by half (< 50%) within the first 2 weeks’ therapy is CRY 100% vs. SYM 78% and total rate is 85%. - seizure free within the total 8 weeks’ therapy is CRY 100% vs. SYM 67% and total rate is 77% (10 infants). - in these 10 seizure free infants, seizure recurrence/relapse is CRY 25% vs. SYM 67% and total rate is 50%.

Conclusions ACTH is an effective agent to treat epileptic spasms. Cryptogenic group has better outcomes. There is clinical response to ACTH therapy in 85% of patients within the first 2 weeks. Relapse rate is high in 50% of total seizure-free patients with mean interval 5.6 months. Symptomatic group has lower seizure-free rate and higher recurrence rate then cryptogenic group.
Keywords: ACTH, Epileptic spasms, Infantile spasms, Cryptogenic, Symptomatic, Relapse