Very high dose prednisolone reasonable alternative to ACTH for children with infantile spasms

A pilot study to determine the best hormonal treatment for infantile spasms (IS) that may lead to changes in prescribing practices for hormone therapy is being presented for the first time at the American Epilepsy Society's 66th Annual Meeting in San Diego California.

In a study of 30 infants, researchers from the division of Pediatric Neurology of Mattel Children's Hospital at UCLA in Los Angeles found very high dose prednisolone to be a reasonable alternative to adrenocorticotropic hormone treatment (ACTH) for children with infantile spasms . Using a standardized protocol in which ACTH is reserved for infants who do not respond to prednisolone, they yielded a favorable overall response rate of 77%, and were able to successfully forego ACTH therapy in 18 patients, thus avoiding more than 1000 intramuscular injections and achieving more than 2 million dollars in short-term cost savings. The results indicate that further research is warranted to determine whether high dose prednisolone is truly equivalent is ACTH, as 5 infants in this study responded to ACTH after failing prednisolone.

"In the absence of a definitive clinical trial, I encourage practitioners to use the treatment protocol set forth in our study to mitigate the risks and cost of traditional ACTH therapy. However, I do not advocate that ACTH therapy be completely abandoned. A head-to-head trial of high-dose prednisolone versus ACTH is required to resolve the uncertainly that remains." said Dr. Shaun Hussain of the Division of Neurology, Mattel Children's Hospital at UCLA, the lead author of the study.