Comparison of the Effect of High and Low Doses of Adrenocorticotropic Hormone (ACTH) in the Management of Infantile Spasms

Afshin Fayyazi, Reihane Eslamian, Ali Khajeh, maryam Dehghani



Introduction:Infantile spasmscan have irrecoverable adverse effects on a child’s brain. Adrenocorticotropic hormone (ACTH) is the most common first line medication for its treatment; however, the suitable dose and duration of treatment continue to be debated among specialists. The common high doses of this drug can produce more side effects; thus, lower doses are preferred. The aim of this study is to determine the effect and extent of complicationscaused by high and low doses of ACTH for children suffering from infantile spasms.

Materials and methods:This study is a clinical trial in which 32 infants from 1.5 and 18 months of age suffering from infantile spasms were divided into high and low dose ACTH groups. Treatment lasted for two months. The therapeutic effects and their complications were then compared over the course of 18 months.

Results:The results indicate thatthere were no significant differences between groups for short-term prognosis of controlling convulsions, final prognosis of patients for spasm relapse, EEG changes after treatment, post-treatment evolution and development of hypertension. However, there was a significant difference in the frequency distribution for intensity of restlessness and becoming Cushingoid, which were more frequent in the high dose group.

Conclusion:These results indicate that high and low dose ACTH are equally effective in terms of controlling spasms, yet the low dose brings about fewer side effects.


Infantile spasms, ACTH therapy, dosage, Side effects

Full Text:




Hrachovy RA, Frost JD Jr. Infantile epileptic encephalopathy with hypsarrhythmia (infantile spasms/West syndrome). J ClinNeurophysiol.2003; 20:408–425.

Scantlebury MH, Galanopoulou AS, Chudomelova L, et al. A model of symptomatic infantile spasms syndrome. Neurobiol Dis .2010; 37:604–612.

Pavone P, Striano P, Falsaperla R, Pavone L, Ruggieri M. Infantile spasms syndrome, West syndrome and related phenotypes: what we know in 2013. Brain Dev. 2014; 36:739–51.

Curatolo P, Verdecchia M, Bombardieri R. (2002) Tuberous sclerosis complex: a review of neurological aspects. Eur J PaediatrNeurol 6:15–23.

Nelson GR. Management of infantile spasms. TranslPediatr. 2015; 4(4):260–70.

Kossof EH. Infantile spasms. Neurologist. 2010; 2:69–75.

O'Callaghan FJK, Lux AL, Darke K, Edwards SW, Hancock E, Johnson AL, Kennedy CR, Newton RW, Verity CM, Osborne JP. (2011) the effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: evidence from the United Kingdom Infantile Spasms Study. Epilepsia 52:1359–1364.

Auvin S, Hartman AL, Desnous B, Moreau AC, Alberti C, Delanoe C, et al. Diagnosis delay in West syndrome: misdiagnosis and consequences. Eur J Pediatr. 2012; 171:1695–701.

Knupp KG, Coryell J, Nickels KC, Ryan N, Leister E, Loddenkemper T, et al. Response to treatment in a prospective National Infantile Spasms cohort. Ann Neurol. 2016; 79:475–84.

Widjaja E, Go C, McCoy B, Snead OC. Neurodevelopmental outcome of infantile spasms: a systematic review and meta-analysis. Epilepsy Res. 2015; 109:155–62.

Wanigasinghe J, Arambepola C, Ranganathan SS, Sumanasena S, Muhandiram EC. The efficacy of moderate-to-high dose oral prednisolone versus low-to-moderate dose intramuscular corticotropin for improvement of hypsarrhythmia in West syndrome: a randomized, single-blind, parallel clinical trial. Pediatr Neurol. 2014; 51:24–30.

Pellock JM, Hrachovy R, Shinnar S, et al. Infantile spasms: a U.S. consensus report. Epilepsia 2010; 51:2175-89. [PubMed]

Mytinger JR, Joshi S; Pediatric Epilepsy Research Consortium, et al. The current evaluation and treatment of infantile spasms among members of the Child Neurology Society. J Child Neurol 2012; 27:1289-94.

Hancock EC, Osborne JP, Edwards SW. Treatment of infantile spasms. Cochrane Database Syst Rev 2013; 6:CD001770.

Caraballo RH, Ruggieri V, Gonzalez G, Cerosimo R, Gamboni B, Rey A, et al. Infantile spasms without hypsarrhythmia: a study of 16 cases. Seizure. 2011; 20:197–202.

Thelle T, Gammelgaard L, Hansen JK, et al. Reversible magnetic resonance imaging and spectroscopy abnormalities in the course of vigabatrin treatment for West syndrome. Eur J PaediatrNeurol 2011; 15:260-4.

Go CY, Mackay MT, Weiss SK, Stephens D, Adams-Webber T, Ashwal S, et al. Evidence-based guideline update: medical treatment of infantile spasms. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.Neurology. 2012; 78(24):1974–80.

Stafstrom CE, Arnason BGW, Baram TZ, Catania A, Cortez MA, Glauser TA, et al. Treatment of infantile spasms: emerging insights from clinical and basic science perspectives. J Child Neurol. 2011; 26:1411–21.

Wilmshurst JM, Ibekwe RC, O’ Callaghan FJK. Epileptic spasms—175 years on: trying to teach and old dog new tricks. Seizure.2017; 44:81–6.

Shumiloff NA, Man Lam W, Manasco KB. Adrenocorticotropic hormone for the treatment of West syndrome in children. Ann Pharmacother. 2013; 47:744–54.

M. Iype, G. Saradakutty, P.A. Kunju, D. Mohan, M.K. Nair, B. George, et al.

Infantile spasms: a prognostic evaluation

Ann Indian AcadNeurol, 19 (2) (2016), pp. 228-235

Pesaturo KA, Spooner LM, Belliveau P. Vigabatrin for infantile spasms. Pharmacotherapy 2011; 31:298-311.

Riikonen R. Combination therapy for treatment of infantile spasms. Lancet Neurol. 2017; 16:19–20.

Hayashi Y, Yoshinaga H, Akiyama T, Endoh F, Ohtsuka Y, Kobayashi K. Predictive factors for relapse of epileptic spasms after adrenocorticotropic hormone therapy in West syndrome. Brain Dev. 2016 Jan; 38(1):32–39.

Yanagaki S, Oguni H, Hayashi K. A comparative study of high-dose and low-dose ACTH therapy for West syndrome. Brain Dev. 1999; 01: 641– 647.

Hrachovy RA, Frost JD Jr, Glaze DG. High-dose, long-duration versus low-dose, short-duration corticotropin therapy for infantile spasms.J Pediatr. 1994 May;124(5).

Ito M1, Okuno T, FujiiT,et al. ACTH therapy in infantile spasms: relationship between dose of ACTH and initial effect or long-term prognosis. Pediatr Neurol. 1994Jul-Aug;4(6):240-4.

Zeng L, Luo R, Zhang L. Efficacy of high-dose ACTH versus low-dose ACTH in infantile spasms: a meta-analysis with direct and indirect comparison of randomized trials. Journal of Pediatric Neurology 2011; 9(2): 141-149.

Lagae L, Verhelst H, CeulemansB,et al. Treatment and long term outcome in West syndrome: the clinical reality. A multicentre follows up study. Seizure. 2010 Apr; 19(3):159-64.

Taghdiri MM. Presentation of 44 cases of infantile spasms based on etiology, clinical manifestation, EEG and brain CT scan in Mofid Children’s Hospital.JRehab. 2002; 3(8-9); 39-42.

C.Y. Go, M.T. Mackay, S.K. Weiss, et al. Evidence-based guideline update: Medical treatment of infantile spasms. Neurology. 2012; 78; 1974-1980.



  • There are currently no refbacks.

Copyright (c) 2020 Iranian Journal of Child Neurology