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Topiramate and Adrenocorticotropic Hormone (ACTH) as Initial Treatment for Infantile Spasms

¹ Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
² Division of Neurology, The Children's Hospital of Philadelphia, and Depts of Neurology and Pediatrics, University of Pennsylvania Medical School, Philadelphia

^* To whom correspondence should be addressed. E-mail: porterb{at}email.chop.edu.

	Abstract

Historically, adrenocorticotropic hormone was used as a first-line treatment for infantile spasms; however, there has been increasing use of topiramate as initial therapy. Here, we report a retrospective study of adrenocorticotropic hormone (ACTH) and topiramate as initial treatment for infantile spasms. The neurology patient database at the Children’s Hospital of Philadelphia was searched using the International Classification of Diseases, Ninth Revision code for infantile spasms, and 50 patients were randomly chosen for chart review. We identified 31 patients receiving either adrenocorticotropic hormone or topiramate monotherapy (adrenocorticotropic hormone n = 12, topiramate n = 19) as a first-line treatment for infantile spasms. A total of 26 patients were symptomatic and 5 cryptogenic. Six patients treated with adrenocorticotropic hormone had resolution of clinical spasms and hypsarrhithmia within a month, but 3 relapsed. Of the 19 patients treated with topiramate, 4 patients eventually, though over a period of 0, 1, 8, or 69 months, had resolution of spasms and hypsarrhythmia.

First published on February 18, 2009, doi:10.1177/0883073808324538

Journal of Child Neurology 2009;24:400.

A more recent version of this article appeared on April 1, 2009


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