Long-term analysis of adrenocorticotropic hormone monotherapy for infantile epileptic spasms syndrome with periventricular leukomalacia

• Published in: Seizure (London, England) Vol. 109; pp. 40 - 44
• Main Authors: Matsuura, Ryuki, Hamano, Shin-ichiro, Hirata, Yuko, Takeda, Rikako, Takeuchi, Hirokazu, Koichihara, Reiko, Kikuchi, Kenjiro, Oka, Akira
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2023
• Subjects: Adverse effect; Child; Epilepsy; Hypsarrhythmia; Infantile epileptic spasms syndrome; Prognosis; Prognosis; Infantile epileptic spasms syndrome; Epilepsy; EEG; PVL; ACTH; IQ; IVIG; Adverse effect; DQ; ID; Child; Hypsarrhythmia
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2023.05.012

•ACTH monotherapy outcomes assessed for infantile epileptic spasm syndrome and PVL.•A positive response was observed in seven of 12 patients (58.3%).•Epileptic discharge in the parieto-occipital region was associated with relapse.•PVL grade III was also associated with relapse.•Our results will help identify patients at risk of relapse post-ACTH therapy. Infantile epileptic spasms syndrome (IESS) with periventricular leukomalacia (PVL) has a poor neurological prognosis. Adrenocorticotropic hormone (ACTH) and vigabatrin therapies are the recommended first-line treatments for IESS. However, ACTH monotherapy for IESS with PVL has not been studied in detail. We analysed long-term outcomes of ACTH monotherapy for IESS with PVL. We retrospectively examined 12 patients with IESS and PVL at Saitama Children's Medical Center between January 1993 and September 2022. We evaluated seizure outcomes 3 months post-ACTH therapy and at the last visit. We also assessed electroencephalography findings and developmental outcomes. A positive response was defined as complete remission of epileptic spasms, no other seizure types, and hypsarrhythmia resolution post-ACTH therapy. The median onset age of epileptic spasms was 7 (range: 3–14) months. The median age at initiation of ACTH therapy was 9 (7–17) months. Seven of 12 patients (58.3%) showed a positive response. The median age at the last visit was 5 years and 6 months (1 year and 5 months–22 years and 2 months). At the last visit, only 2 of 7 initial responders remained seizure-free who demonstrated normal electroencephalography findings within 1-month post-ACTH therapy. Patients with epileptic discharge in the parieto-occipital region within 1-month post-ACTH therapy showed relapse of epileptic spasms or other seizure types. Patients having epileptic discharge in the parietal or occipital regions on electroencephalography within 1-month post-ACTH therapy may be at a high risk of epileptic spasm recurrence or other seizure types in the long term.