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Hirata Y, Hamano SI, Hirano D, Matsuura R, Koichihara R, Takeda R, Takeuchi H, Kikuchi K. Early Response, Long-Term Seizure Outcome, and Very-Low-Dose Adrenocorticotrophic Hormone Therapy for Infantile Epileptic Spasms Syndrome With Down Syndrome. Pediatr Neurol 2024; 156:191-197. [PMID: 38795573 DOI: 10.1016/j.pediatrneurol.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 04/10/2024] [Accepted: 04/28/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Infantile epileptic spasms syndrome (IESS) with Down syndrome has good treatment response and good seizure outcomes with high-dose adrenocorticotrophic hormone (ACTH) therapy. We investigated the early treatment response of epileptic spasms (ES), long-term seizure outcome, and efficacy of very-low-dose ACTH therapy for IESS with Down syndrome. METHODS We retrospectively investigated patients with Down syndrome and IESS between April 1983 and January 2023. We defined response to treatment as clinical remission and electrographic resolution of hypsarrhythmia after treatment for more than one month and early treatment as any treatment for ES within three months of initiation of treatment. Long-term seizure outcomes were determined by the presence of any type of seizure within one year of the last visit. We investigated the dosage and efficacy of very-low-dose ACTH therapy. RESULTS Thirty patients were enrolled with a median follow-up period of 7.7 years (range: 1.3 to 19.1). The response and relapse rates in the early treatment were 83.3% and 16.0%, respectively. The seizure-free rate of long-term seizure outcomes was 80.0%. Long-term seizure outcomes correlated with early treatment response to ES. The response rate of very-low-dose ACTH therapy was 59.3%. The efficacy of ACTH therapy tended to be dose-dependent (P = 0.055). CONCLUSIONS Early treatment response to ES may be useful in predicting long-term seizure outcomes of IESS with Down syndrome. Very-low-dose ACTH therapy was the most effective treatment for ES and could exhibit dose-dependent efficacy. Depending on the IESS etiology, the ACTH dose could be reduced to minimize its side effects.
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Affiliation(s)
- Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan; Department for Child Health and Human, Saitama Children's Medical Center, Saitama, Japan
| | - Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Reiko Koichihara
- Department for Child Health and Human, Saitama Children's Medical Center, Saitama, Japan
| | - Rikako Takeda
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Hirokazu Takeuchi
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
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Sharma S, Dabla S, Kaushik JS. Modified Atkins Diet vs. Ketogenic Diet in the Management of Children with Epileptic Spasms Refractory to First Line Treatment: An Open Labelled, Randomized Controlled Trial. Indian J Pediatr 2023; 90:969-973. [PMID: 37233891 DOI: 10.1007/s12098-023-04527-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/03/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To compare the efficacy and tolerability of modified Atkins diet (mAD) and ketogenic diet (KD) among children aged 9 mo to 3 y with epileptic spasms refractory to the first line treatment. METHODS An open labelled, randomized controlled trial with parallel group assignment was conducted among children aged 9 mo to 3 y with epileptic spasms refractory to the first line treatment. They were randomized to either receive the mAD along with conventional anti-seizure medications (n = 20) or KD with conventional anti-seizure medications (n = 20). Primary outcome measure was proportion of children who achieved "spasm freedom" at 4 wk and 12 wk. Secondary outcome measures were proportion of children who achieved >50% and >90% reduction in spasms at 4 wk and 12 wk, nature and proportion of the adverse effects as per parental reports. RESULTS Proportion of children achieving spasm freedom [mAD {4 (20%)} vs. KD {3 (15%)}: OR (95% CI) 1.42 (0.27-7.34); P = 0.67], >50% spasm reduction [mAD {3 (15%)} vs. KD {5 (25%)}: OR (95% CI) 0.53 (0.11-2.59); P = 0.63] and >90% spasm reduction [mAD {4 (20%)} vs. KD {2 (10%)}: OR (95% CI) 2.25 (0.36-13.97); P = 0.41] was comparable between the two groups at 12 wk. The diet was well tolerated in both the groups with vomiting and constipation being the most common reported adverse effect. CONCLUSIONS mAD is an effective alternative to KD in the management of children with epileptic spasms refractory to first line treatment. However, further studies with adequately powered sample size and longer follow-up are required. TRIAL REGISTRATION CTRI/2020/03/023791.
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Affiliation(s)
- Shobhna Sharma
- Department of Pediatrics, Pt B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Surekha Dabla
- Department of Neurology, Pt B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Jaya Shankar Kaushik
- Department of Pediatrics, All India Institute of Medical Sciences, Guwahati, Assam, 781101, India.
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Matsuura R, Hamano SI, Hirata Y, Takeda R, Takeuchi H, Koichihara R, Kikuchi K, Oka A. Long-term analysis of adrenocorticotropic hormone monotherapy for infantile epileptic spasms syndrome with periventricular leukomalacia. Seizure 2023; 109:40-44. [PMID: 37207538 DOI: 10.1016/j.seizure.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan.
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Rikako Takeda
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan.
| | - Hirokazu Takeuchi
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Reiko Koichihara
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan.
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Akira Oka
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan.
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Wang Q, He W, Wang Y, Liu L, Zhang M, Yang X, Zou L. Response to magnesium sulfate and adrenocorticotropic hormone combination therapy for infantile spasms with failed first‐line treatments. Pediatr Investig 2023; 7:29-35. [PMID: 36967744 PMCID: PMC10030695 DOI: 10.1002/ped4.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/07/2022] [Indexed: 03/11/2023] Open
Abstract
Importance Infantile spasm (IS) is a kind of refractory epilepsy. The first-line treatments for IS are adrenocorticotropic hormone (ACTH), oral corticosteroids, and vigabatrin. Objective This study aimed to evaluate the efficacy of magnesium sulfate and ACTH (MgSO4+ACTH) combination therapy in patients with IS who failed first-line treatments. Methods In this retrospective study, the clinical data of patients with IS who failed first-line treatments were collected in the Chinese PLA General Hospital. Patients received MgSO4+ACTH combination therapy after first-line treatments failed. The course of treatments was 2 weeks. The therapeutic dose of ACTH and MgSO4 was 2.5 U·kg-1·d-1 and 0.25 g·kg-1·d-1, respectively. Results A total of 229 patients with IS who failed the first-line treatments were collected. At the end of the MgSO4+ACTH combination treatment, the seizure-free rate was 48.5% (111/229), and the resolution of hypsarrhythmia on electroencephalogram (EEG) was 72.1% (165/229). About 21.4% (49/229) of patients showed side effects, including infectious diseases, hypokalemia, and diarrhea. Interpretation For patients with IS who failed first-line treatments, in terms of the seizure-free rate and resolution of hypsarrhythmia on EEG, MgSO4+ACTH combination therapy can be considered.
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Affiliation(s)
- Qiuhong Wang
- Department of Pediatrics Chinese PLA General Hospital The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Wen He
- Department of Pediatrics Chinese PLA General Hospital The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Yangyang Wang
- Department of Pediatrics Chinese PLA General Hospital The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Liying Liu
- Department of Pediatrics Chinese PLA General Hospital The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Mengna Zhang
- Department of Pediatrics Chinese PLA General Hospital The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Xiaoyan Yang
- Department of Pediatrics Chinese PLA General Hospital The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Liping Zou
- Department of Pediatrics Chinese PLA General Hospital The First Medical Center of Chinese PLA General Hospital Beijing China
- Department of Pediatrics, Beijing Institute for Brain Disorders, Center for Brain Disorders Research Capital Medical University Beijing China
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Operto FF, Pastorino GMG, Viggiano A, Dell’Isola GB, Dini G, Verrotti A, Coppola G. Epilepsy and Cognitive Impairment in Childhood and Adolescence: A Mini-Review. Curr Neuropharmacol 2023; 21:1646-1665. [PMID: 35794776 PMCID: PMC10514538 DOI: 10.2174/1570159x20666220706102708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Managing epilepsy in people with an intellectual disability remains a therapeutic challenge and must take into account additional issues such as diagnostic difficulties and frequent drug resistance. Advances in genomic technologies improved our understanding of epilepsy and raised the possibility to develop patients-tailored treatments acting on the key molecular mechanisms involved in the development of the disease. In addition to conventional antiseizure medications (ASMs), ketogenic diet, hormone therapy and epilepsy surgery play an important role, especially in cases of drugresistance. This review aims to provide a comprehensive overview of the mainfactors influencing cognition in children and adolescents with epilepsy and the main therapeutic options available for the epilepsies associated with intellectual disability.
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Affiliation(s)
- Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Andrea Viggiano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, SA, Italy
| | | | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
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Jain P, Sahu JK, Horn PS, Chau V, Go C, Mahood Q, Arya R. Treatment of children with infantile spasms: A network meta-analysis. Dev Med Child Neurol 2022; 64:1330-1343. [PMID: 35765990 DOI: 10.1111/dmcn.15330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022]
Abstract
AIM We performed a systematic review and network meta-analysis (NMA) to obtain comparative effectiveness estimates and rankings of non-surgical interventions used to treat infantile spasms. METHOD All randomized controlled trials (RCTs) including children 2 months to 3 years of age with infantile spasms (with hypsarrhythmia or hypsarrhythmia variants on electroencephalography) receiving appropriate first-line medical treatment were included. Electroclinical and clinical remissions within 1 month of starting treatment were analyzed. RESULTS Twenty-two RCTs comparing first-line treatments for infantile spasms were reviewed; of these, 17 were included in the NMA. Both frequentist and Bayesian network rankings for electroclinical remission showed that high dose adrenocorticotropic hormone (ACTH), methylprednisolone, low dose ACTH and magnesium sulfate (MgSO4 ) combination, low dose ACTH, and high dose prednisolone were most likely to be the 'best' interventions, although these were not significantly different from each other. For clinical remission, low dose ACTH/MgSO4 combination, high dose ACTH (with/without vitamin B6 ), high dose prednisolone, and low dose ACTH were 'best'. INTERPRETATION Treatments including ACTH and high dose prednisolone are more effective in achieving electroclinical and clinical remissions for infantile spasms. WHAT THIS PAPER ADDS Adrenocorticotropic hormone and high dose prednisolone are more effective than other medications for infantile spasms. Symptomatic etiology decreases the likelihood of remission even after adjusting for treatment lag.
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Affiliation(s)
- Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jitendra K Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Vann Chau
- Neonatal Neurology Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cristina Go
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Quenby Mahood
- Hospital Library and Archives, Learning Institute, Toronto, ON, Canada
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Yang G, Wan L, Zhang S, Shi X, Wang J, Hu L, Zou L. CLOCK, SIRT1, and HDAC2 Knockdown along with Melatonin Intervention Significantly Decreased the Level Glucocorticoid Receptor. RUSS J GENET+ 2022. [DOI: 10.1134/s1022795422010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Matsuura R, Hamano SI, Daida A, Horiguchi A, Nonoyama H, Kubota J, Ikemoto S, Hirata Y, Koichihara R, Kikuchi K. Serum matrix metallopeptidase-9 and tissue inhibitor of metalloproteinase-1 levels may predict response to adrenocorticotropic hormone therapy in patients with infantile spasms. Brain Dev 2022; 44:114-121. [PMID: 34429218 DOI: 10.1016/j.braindev.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether serum matrix metallopeptidase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels predict response to adrenocorticotropic hormone (ACTH) therapy in patients with infantile spasms. METHODS We prospectively evaluated patients with infantile spasms who were referred to Saitama Children's Medical Center from January 2011 to December 2020. We measured Q-albumin and serum MMP-9 and TIMP-1 levels before ACTH therapy. Patients were divided into three groups based on the etiology of their infantile spasms: those with an unknown etiology and normal development (unknown-normal group); those with a structural and acquired etiology (structural-acquired group); and those with a structural and congenital, genetic, metabolic, or unknown etiology with developmental delay (combined-congenital group). Responders were defined as those having complete cessation of spasms for more than 3 months with the resolution of hypsarrhythmia on electroencephalography during ACTH therapy. RESULTS We collected serum from 36 patients with West syndrome and five patients with infantile spasms without hypsarrhythmia before ACTH therapy. Twenty-three of 41 patients (56.1%) were responders, including 8/8 (100%) in the unknown-normal group, 6/9 (66.7%) in the structural-acquired group, and 9/24 (37.5%) in the combined-congenital group. The serum MMP-9 level and MMP-9/TIMP-1 ratio were significantly higher in responders than in nonresponders (P = 0.001 for both). CONCLUSION A therapeutic response to ACTH was associated with a higher serum MMP-9 level and higher MMP-9/TIMP-1 ratio in patients with infantile spasms. Therefore, these biomarkers may predict responses to ACTH therapy in this patient population.
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Affiliation(s)
- Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan
| | - Atsuro Daida
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan
| | - Ayumi Horiguchi
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan
| | - Hazuki Nonoyama
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Jun Kubota
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Satoru Ikemoto
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Reiko Koichihara
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
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9
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Matsuura R, Hamano SI, Ikemoto S, Daida A, Takeda R, Horiguchi A, Hirata Y, Koichihara R, Kikuchi K. Adjunctive perampanel therapy for patients with epileptic spasms. Pediatr Int 2022; 64:e15364. [PMID: 36564346 DOI: 10.1111/ped.15364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Perampanel is an antiepileptic drug. Some studies have documented the efficacy of perampanel in epileptic spasms. We aimed to evaluate the efficacy and safety of adjunctive perampanel therapy (PT) in patients with epileptic spasms. METHODS We retrospectively surveyed the efficacy and safety of adjunctive PT in 14 patients with epileptic spasms at the Saitama Children's Medical Center between June 2016 and September 2021. Seizure outcomes and safety were evaluated 12 months after commencing PT. Response to perampanel was defined as complete remission of epileptic spasms for more than 3 months. RESULTS The median age at onset of epileptic spasms was 0.4 years (range, 0.1-1.3 years). The etiology was structural in 11 patients, genetic in two, and unknown in one. The median age at the commencement of PT was 3.2 years (1.5-10.3 years). The initial and maintenance doses of perampanel were administered at 0.04 (range, 0.02-0.05) mg/kg/day and 0.12 (range, 0.03-0.24) mg/kg/day, respectively. Five of the 14 patients (35.7%) showed remission of epileptic spasms for more than 3 months at 12 months after PT; these patients had a structural etiology. The median duration between commencement of perampanel and spasm remission was 2 months (range, 1-6 months). No serious adverse effects occurred. CONCLUSIONS This is the first case series evaluating adjunctive PT for epileptic spasms. PT is worth investigating to treat epileptic spasms in patients with structural etiologies. As our study population primarily comprised children aged 2 years and older, PT may be useful for epileptic spasms beyond infancy.
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Affiliation(s)
- Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan.,Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Satoru Ikemoto
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan.,Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Atsuro Daida
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Rikako Takeda
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Ayumi Horiguchi
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan.,Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Reiko Koichihara
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan.,Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
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Ueda Y, Fujishige S, Goto T, Kimura S, Namatame N, Narugami M, Nakakubo S, Nakajima M, Egawa K, Kaneko N, Nakayama K, Hishimura N, Yamaguchi T, Nakamura A, Shiraishi H. Adrenal function during long-term ACTH therapy for patients with developmental and epileptic encephalopathy. Epilepsia Open 2021; 7:194-200. [PMID: 34862857 PMCID: PMC8886065 DOI: 10.1002/epi4.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/09/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022] Open
Abstract
Some patients with developmental and epileptic encephalopathy (DEE) respond to adrenocorticotropic hormone (ACTH) therapy but relapse soon after. While long‐term ACTH therapy (LT‐ACTH) has been attempted for these patients, no previous studies have carefully assessed adrenal function during LT‐ACTH. We evaluated the effectiveness of LT‐ACTH, as well as adverse effects (AE), including their adrenal function in three DEE patients. Patients underwent a corticotropin‐releasing hormone (CRH) stimulation test during LT‐ACTH, and those with peak serum cortisol below 15 μg/dL were considered to be at high risk of adrenal insufficiency (AI). Two of three responded, and their life‐threatening seizures with postgeneralized electroencephalogram (EEG) suppression decreased. Although no individuals had serious AE, CRH stimulation test revealed relatively weak responses, without reaching normal cortisol peak level (18 μg/dL). Hydrocortisone replacement during stress was prepared in a case with lower cortisol peak than our cutoff level. LT‐ACTH could be a promising treatment option for cases of DEE that relapse soon after effective ACTH treatment. The longer duration and larger cumulative dosage in LT‐ACTH than in conventional ACTH could increase the relative risk of AI. Careful evaluation with pediatric endocrinologists, including hormonal stimulation tests, might be useful for continuing this treatment safely.
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Affiliation(s)
- Yuki Ueda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Shuta Fujishige
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takeru Goto
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Shuhei Kimura
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Noriko Namatame
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Masashi Narugami
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiko Nakakubo
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Midori Nakajima
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyoshi Egawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Naoya Kaneko
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Kanako Nakayama
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Nozomi Hishimura
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takeshi Yamaguchi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Akie Nakamura
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
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11
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Gilboa I, Israeli G, Brener A, Yackobovitch-Gavan M, Kramer U, Uliel-Sibony S, Lebenthal Y. Cardiometabolic outcomes in children and adolescents with West syndrome. BMC Pediatr 2021; 21:412. [PMID: 34537045 PMCID: PMC8449498 DOI: 10.1186/s12887-021-02871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/28/2021] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND West syndrome is a convulsive disorder of infancy with unique seizures and a characteristic background electroencephalograph pattern. Adrenocorticotropic hormone (ACTH) is effective in spasm cessation, yet metabolic consequences of this therapeutic agent in childhood have not been published. METHODS In this observational study we explored the cardiometabolic outcomes of 117 children with West syndrome (78 ACTH-treated and 39 non-ACTH-treated) monitored at a single medical center from 1995 to 2019 (median follow-up 7.2 years). Outcomes included the prevalence of cardiometabolic derangements (obesity, hypertension, and dyslipidemia) during infancy (< 2 years), early childhood (2-6 years), and childhood/adolescence (6-18 years). RESULTS The rates of metabolic derangements during infancy in the West syndrome cohort were high compared to childhood/adolescence (obesity 27.3 % vs. 3.3 %, [p = 0.010], diastolic hypertension 48.8 % vs. 5.1 % [p < 0.001], hypertriglyceridemia 71 % vs. 40 % [p = 0.008], low high-density lipoprotein cholesterol [HDL-c] 54.2 % vs. 12.9 % [p = 0.001], and elevated triglycerides/HDL-c ratios 62.5 % vs. 12.9 % [p < 0.001]). The proportion of systolic and/or diastolic blood pressure levels categorized as hypertensive was 58.5 % during infancy, 48.1 % during early childhood, and 26.3 % during childhood/adolescence. ACTH-treated patients had higher weight and weight-to-length z-scores and higher triglyceride levels during infancy compared to non-ACTH-treated patients (p = 0.008, p = 0.001, and p = 0.037, respectively), and higher triglyceride levels during early childhood (p = 0.050), with no significant group differences during childhood/adolescence. CONCLUSIONS Children with West syndrome apparently have an increased prevalence of cardiometabolic derangements more pronounced in infants and in ACTH-treated patients. These findings highlight the need to monitor these children for cardiometabolic derangements, even though these cardiometabolic abnormalities are transitory and tend to decrease with time. The health implications of cardiometabolic derangements during critical windows of growth and development warrant further investigation.
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Affiliation(s)
- Inbar Gilboa
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Brener
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kramer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shimrit Uliel-Sibony
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Lebenthal
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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12
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Baba S, Okanishi T, Homma Y, Yoshida T, Goto T, Fukasawa T, Kobayashi S, Kamei A, Fujii Y, Hino‐Fukuyo N, Yamada K, Daida A, Kawawaki H, Hoshino H, Sejima H, Ishida Y, Okazaki T, Inui T, Kanai S, Motoi H, Itamura S, Nishimura M, Enoki H, Fujimoto A. Efficacy of long-term adrenocorticotropic hormone therapy for West syndrome: A retrospective multicenter case series. Epilepsia Open 2021; 6:402-412. [PMID: 34095686 PMCID: PMC8166796 DOI: 10.1002/epi4.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Long-term adrenocorticotropic therapy (LT-ACTH), which consisted of 2-4 weeks of daily injections of adrenocorticotropic hormone (ACTH) and subsequent months of weekly injections, was tried for relapsed West syndrome (WS) or other intractable epilepsies in small case reports. Our aim was to explore the efficacy of LT-ACTH for preventing WS relapse, as well as the prevalence of its adverse events. METHODS This is a retrospective, nationwide, multicenter case series of patients with WS who underwent LT-ACTH. Clinical information of the patients and protocol of LT-ACTH were collected from participating institutes in this study. We defined clinical response to ACTH as achievement of hypsarrhythmia and epileptic spasms resolution. Patients who responded to daily ACTH injections were identified and assessed whether they experienced WS relapse during/after the weekly ACTH injection period. The outcome was measured by the nonrelapse rate at 24 months after daily ACTH injections using the Kaplan-Meier method. RESULTS Clinical information of 16 children with WS was analyzed. The median age at LT-ACTH initiation was 14.5 months (range: 7-68 months). Thirteen (81%) patients had previously undergone conventional ACTH treatment. The LT-ACTH regimens comprised a median of 16 days of daily injections (range: 11-28 days) and 10 months of weekly injections (range: 3-22 months). Seven patients experienced WS relapse during/after subsequent weekly ACTH period, and the nonrelapse rate at 24 months after daily injections was estimated at 60.6% (95% confidence interval: 32.3%-80.0%). Height stagnation, hypertension, and irritability were observed; lethal adverse events were not reported. SIGNIFICANCE Our study firstly explored the efficacy of LT-ACTH for preventing WS relapse. LT-ACTH might be a treatment option for patients with relapsed or intractable WS; however, we note that our study is limited by its small sample size and the lack of an appropriate control group.
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Affiliation(s)
- Shimpei Baba
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Tohru Okanishi
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Yoichiro Homma
- General Internal MedicineSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Takeshi Yoshida
- Department of PediatricsKyoto University Graduate School of MedicineKyotoJapan
| | - Tomohide Goto
- Department of NeurologyKanagawa Children's Medical CenterYokohamaJapan
| | | | - Satoru Kobayashi
- Department of PediatricsNagoya City West Medical CenterNagoyaJapan
| | - Atsushi Kamei
- Department of PediatricsIwate Medical University School of MedicineShiwaJapan
| | - Yuji Fujii
- Department of PediatricsHiroshima City Funairi Citizens HospitalHiroshimaJapan
| | - Naomi Hino‐Fukuyo
- Department of PediatricsTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Keitaro Yamada
- Department of Pediatric NeurologyAichi Developmental Disability Center Central HospitalKasugaiJapan
| | - Atsuro Daida
- Department of PediatricsSt. Luke's International HospitalTokyoJapan
| | - Hisashi Kawawaki
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
| | - Hideki Hoshino
- Department of PediatricsTeikyo University School of MedicineTokyoJapan
| | - Hitoshi Sejima
- Department of PediatricsMatsue Red‐Cross HospitalMatsueJapan
| | - Yusuke Ishida
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Tetsuya Okazaki
- Division of Child NeurologyDepartment of Brain and NeurosciencesSchool of MedicineTottori University Faculty of MedicineYonagoJapan
| | - Takehiko Inui
- Department of Pediatric NeurologyMiyagi Children's HospitalMiyagiJapan
| | - Sotaro Kanai
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Hirotaka Motoi
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Shinji Itamura
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Mitsuyo Nishimura
- Division of Clinical LaboratorySeirei Hamamatsu General HospitalHamamatsuJapan
| | - Hideo Enoki
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Ayataka Fujimoto
- Epilepsy and SurgeryComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
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13
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Scalia B, Venti V, Ciccia LM, Criscione R, Lo Bianco M, Sciuto L, Falsaperla R, Zanghì A, Praticò AD. Aristaless-Related Homeobox (ARX): Epilepsy Phenotypes beyond Lissencephaly and Brain Malformations. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1727140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThe Aristaless-related homeobox (ARX) transcription factor is involved in the development of GABAergic and cholinergic neurons in the forebrain. ARX mutations have been associated with a wide spectrum of neurodevelopmental disorders in humans and are responsible for both malformation (in particular lissencephaly) and nonmalformation complex phenotypes. The epilepsy phenotypes related to ARX mutations are West syndrome and X-linked infantile spasms, X-linked myoclonic epilepsy with spasticity and intellectual development and Ohtahara and early infantile epileptic encephalopathy syndrome, which are related in most of the cases to intellectual disability and are often drug resistant. In this article, we shortly reviewed current knowledge of the function of ARX with a particular attention on its consequences in the development of epilepsy during early childhood.
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Affiliation(s)
- Bruna Scalia
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Valeria Venti
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lina M. Ciccia
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Roberta Criscione
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Manuela Lo Bianco
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura Sciuto
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
- Neonatal Intensive Care unit and Neonatology, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Antonio Zanghì
- Department of Medical and Surgical Sciences and Advanced Technology “G.F. Ingrassia,” University of Catania, Catania, Italy
| | - Andrea D. Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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14
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Daida A, Hamano SI, Hayashi K, Nonoyama H, Ikemoto S, Hirata Y, Matsuura R, Koichihara R, Yamanaka G, Kikuchi K. Comparison of adrenocorticotropic hormone efficacy between aetiologies of infantile spasms. Seizure 2020; 85:6-11. [PMID: 33360040 DOI: 10.1016/j.seizure.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We aimed to study the efficacy of adrenocorticotropic hormone (ACTH) treatment on infantile spasms with different aetiologies. In particular, we were interested in patients with structural-acquired aetiology. METHODS Patients with infantile spasms, who were treated with ACTH, were divided into three groups based on the aetiologies: unknown aetiology with normal development (unknown-normal), structural-acquired, and combined-congenital aetiologies that included genetic, metabolic, structural-congenital, or unknown aetiology with developmental delay. RESULTS Of the 107 patients included (58 males, 49 females), 25 patients had unknown-normal aetiology [median age at onset 5 months, standard deviation (SD) 3.12, range 2-16 months]; 20 patients had structural-acquired aetiology (median age at onset 6.5 months, SD 3.85 months, range 4-17 months); and 62 patients had combined-congenital aetiologies (median age at onset 5 months, SD 2.73 months, range 2-16 months). The efficacy of ACTH was 64.0 %, 65 %, and 30.6 % in the unknown-normal aetiology, structural-acquired aetiology, and combined-congenital aetiologies, respectively (p < 0.01). Multivariate analysis showed a statistically significant higher efficacy in the unknown-normal aetiology [Odds ratio (OR) 4.63, 95 % confidence interval (CI) 1.60-13.30] and structural-acquired aetiology (OR 3.41, 95 % CI 1.01-11.50) compared to that in the combined-congenital aetiologies. CONCLUSION Infantile spasms with structural-acquired aetiology had greater response to ACTH treatment than those with combined-congenital aetiologies. The efficacy of standard therapy of infantile spasms should be considered based on aetiology.
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Affiliation(s)
- Atsuro Daida
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan; Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Kuniyoshi Hayashi
- Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji Chuo-ku, Tokyo, Japan
| | - Hazuki Nonoyama
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Satoru Ikemoto
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Reiko Koichihara
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
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15
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Riikonen R, Lähdetie J, Kokki H. ACTH Treatment of Infantile Spasms: Low-Moderate- Versus High-Dose, Natural Versus Synthetic ACTH-A Retrospective Cohort Study. Pediatr Neurol 2020; 111:46-50. [PMID: 32951660 DOI: 10.1016/j.pediatrneurol.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND High dosages of natural adrenocorticotropic hormone are used in many centers in the United States for the treatment of infantile spasms. However, lower dosages of synthetic adrenocorticotropic hormone (tetracosactide) might be equally efficient as high dosages. We analyzed the treatment options for infantile spasms, especially regarding the adrenocorticotropic hormone dosage and the formulation (natural versus synthetic) and evaluated which options were more effective in a retrospective cohort from 1960 to 1976. METHODS We compared the short-term response rates of patients treated with high dosages of natural adrenocorticotropic hormone (120 IU/day) (N = 31) (Group1) with those of patients treated with low-moderate dosages of natural adrenocorticotropic hormone (40 IU/day) (N = 52) (Group2). We also compared the short-term response rates of patients treated with natural adrenocorticotropic hormone (N = 83) with those of patients treated with synthetic adrenocorticotropic hormone, (N = 23) (Group3). The responses were evaluated clinically and by electroencephalography at two to three weeks after the onset of therapy. RESULTS A response was seen in 24 of 31 children treated with high dosages and in 43 of 52 children treated with low-moderate dosages of natural adrenocorticotropic hormone (P = 0.56). All children with an unknown etiology responded to both high and low-moderate dosages of natural adrenocorticotropic hormone. The proportion of children with a good early response to synthetic adrenocorticotropic hormone (16 of 23) did not differ from the proportion of children with a good early response treated with natural adrenocorticotropic hormone (67 of 83) (P = 0.25). CONCLUSIONS High dosages of adrenocorticotropic hormone are not more effective than low-moderate dosages in the short term for treating infantile spasms. Synthetic adrenocorticotropic hormone is equally effective as natural adrenocorticotropic hormone.
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Affiliation(s)
- Raili Riikonen
- Professor in Child Neurology, Children's Hospital, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
| | - Jaana Lähdetie
- Child Neurologist, University of Turku, University Hospital of Turku, Turku, Finland
| | - Hannu Kokki
- Associated Professor in Anesthesiology and Intensive Care Medicine, School of Medicine, University of Eastern, Kuopio, Finland
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16
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McGarry L, Messer R, Cree-Green M, Ray K, Knupp K. Incidence of Hypertension Among Children Treated With Adrenocorticotropic Hormone (ACTH) or Prednisolone for Infantile Spasms. J Child Neurol 2020; 35:215-220. [PMID: 31769329 DOI: 10.1177/0883073819886244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with infantile spasms are often treated with hormonal therapies including adrenocorticotropic hormone (ACTH) and prednisolone. These have numerous systemic side effects including hypertension and, rarely, fatal cardiomyopathy; however, the incidence of these side effects has not been well described. This study aims to quantify the incidence and short-term sequelae of hypertension in this population. A retrospective chart review was performed at a single institution. Children 2 months to 2 years old with newly diagnosed infantile spasms treated from 2013 to 2017 were included. Variables collected included age, sex, etiology and treatment of infantile spasms, documented or missed diagnosis of hypertension, treatment of hypertension, echocardiogram results, referrals for hypertension, and persistence of hypertension 2 to 4 months after treatment. Analyses included descriptive statistics with percentiles, means, and medians. Differences between groups were assessed using Fisher exact tests. Hypertension occurred in 34/77 children (44%) during treatment with ACTH and 4/11 children (36%) during treatment with prednisolone. No child developed hypertension during treatment with nonhormonal therapies. The incidence of hypertension between ACTH and prednisolone groups was not significantly different (P = .75). The incidence of hypertension was significantly higher in the ACTH and prednisolone groups compared to the nonhormonal group (P < .001 for each). Sixteen children received echocardiograms, with no cases of cardiomyopathy. Two children had persistent hypertension at 2 months after discontinuation of hormonal therapy. Hypertension is a very common side effect of hormonal therapy for infantile spasms; however, few developed long-term hypertension and none developed cardiomyopathy. Further study is needed to determine the role of antihypertensive treatment for hormone-related hypertension.
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Affiliation(s)
- Laurel McGarry
- Department of Pediatrics, Division of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ricka Messer
- Department of Pediatrics, Division of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Melanie Cree-Green
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Krista Ray
- Department of Pediatrics, Division of Nephrology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly Knupp
- Department of Pediatrics, Division of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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17
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Hamano SI, Nagai T, Matsuura R, Hirata Y, Ikemoto S, Oba A, Hiwatari E. Treatment of infantile spasms by pediatric neurologists in Japan. Brain Dev 2018; 40:685-692. [PMID: 29731400 DOI: 10.1016/j.braindev.2018.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To clarify changes in clinical practice for infantile spasms, including West syndrome, in Japan over the past two decades. METHODS We investigated common treatment strategies for infantile spasms among 157 pediatric neurologists from a designated training facility for pediatric neurology and/or a designated training facility for epilepsy in Japan. A questionnaire was used to investigate use of adrenocorticotropic hormone (ACTH) therapy including daily dose, treatment duration, and tapering off period, and preferred first to fifth-line treatment choices. RESULTS Among 119 responses (75.8%), 107 enabled analysis of ACTH therapy and 112 were used to determine preferred order of first to fifth-line treatments. Over 80% respondents reported an initial ACTH dose of ≤0.0125 mg/kg/day, with a treatment duration of 14 days and various tapering periods. Following an unfavorable response of seizures to ACTH, 80% respondents increased the dose and/or extended treatment duration. The same ACTH therapy regimen was performed for symptomatic and cryptogenic patients at 95 facilities (88.8%). Preferred orders of therapeutic agents were the same for both symptomatic and cryptogenic patients at 64 facilities (57.1%). Over half the respondents selected vitamin B6 or valproate as the first and second-line treatments instead of ACTH therapy, while ACTH therapy was the most frequently selected third-line treatment. CONCLUSIONS Current ACTH therapy regimens have lower doses and shorter durations than previously reported. However, treatment strategies for infantile spasms have not changed much in two decades. ACTH therapy should be the first/second-line treatment rather than third-line or later, especially for cryptogenic infantile spasms.
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Affiliation(s)
- Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan; Department for Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan.
| | - Toshisaburo Nagai
- Department of Education, Faculty of Education, Poole Gakuin University and College, Osaka, Japan
| | - Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Satoru Ikemoto
- Department for Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Atsuko Oba
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Erika Hiwatari
- Department for Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
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18
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Abstract
West syndrome (WS), also known as infantile spasms, occurs in infancy with a peak between 4 and 7 months. Spasms, neurodevelopmental regression and hypsarrhythmia on electroencephalogram (EEG) basically define WS. The International League Against Epilepsy commission classifies the aetiologies of WS into genetic, structural, metabolic and unknown. Early diagnosis and a shorter lag time to treatment are essential for the overall outcome of WS patients. These goals are feasible with the addition of brain magnetic resonance imaging (MRI) and genetic and metabolic testing. The present work analysed the medical literature on WS and reports the principal therapeutic protocols of its management. Adrenocorticotropic hormone (ACTH), vigabatrin (VGB) and corticosteroids are the first-line treatments for WS. There is no unique therapeutic protocol for ACTH, but most of the evidence suggests that low doses are as effective as high doses for short-term treatment, which is generally 2 weeks followed by dose tapering. VGB is generally administered at doses from 50 to 150 mg/kg/day, but its related retinal toxicity, which occurs in 21-34% of infants, is most frequently observed when treatment periods last longer than 6 months. Among corticosteroids, a treatment of 14 days of oral prednisolone (40-60 mg/day) has been considered effective and well tolerated. Considering that an early diagnosis and a shorter lag time to treatment are essential for successful outcomes in these patients, further studies on efficacy of the different therapeutic approaches with evaluation of final outcome after cessation of therapy are needed.
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19
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You CQ, Wu HS, Gao ZG, Sun K, Chen FH, Tao WA, Sun BW. Subcellular co-delivery of two different site-oriented payloads based on multistage targeted polymeric nanoparticles for enhanced cancer therapy. J Mater Chem B 2018; 6:6752-6766. [PMID: 32254692 DOI: 10.1039/c8tb02230e] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Smart nanoparticles which encapsulated two different site-oriented therapeutic agents for multistage targeted delivery and enhanced antitumor therapy.
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Affiliation(s)
- Chao-Qun You
- School of Chemistry and Chemical Engineering
- Southeast University
- Nanjing 210089
- P. R. China
- College of Chemical Engineering
| | - Hong-Shuai Wu
- School of Chemistry and Chemical Engineering
- Southeast University
- Nanjing 210089
- P. R. China
| | - Zhi-Guo Gao
- School of Chemistry and Chemical Engineering
- Southeast University
- Nanjing 210089
- P. R. China
| | - Kai Sun
- School of Chemistry and Chemical Engineering
- Southeast University
- Nanjing 210089
- P. R. China
| | - Fang-Hui Chen
- School of Chemistry and Chemical Engineering
- Southeast University
- Nanjing 210089
- P. R. China
| | - W. Andy Tao
- Department of Biochemistry
- Purdue University
- West Lafayette
- USA
| | - Bai-Wang Sun
- School of Chemistry and Chemical Engineering
- Southeast University
- Nanjing 210089
- P. R. China
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20
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Abstract
OBJECTIVES West syndrome (also known as infantile spasm because of its main seizure type) is a rare form of epilepsy that begins during early infancy. Recent guidelines and reviews on West syndrome recommend the use of adrenocorticotropic hormone steroids, or vigabatrin, as the first-line treatment. However, West syndrome remains to be one of the most challenging epilepsies to treat. Here, we systematically reviewed the current literature obtained during the previous decade. This article provides an overview of the current treatment of infantile spasms. METHODS PubMed and EMBASE were searched to retrieve studies on human published during 2005-2015 and to identify patients with clinical diagnosis of infantile spasms. Drug or diet treatments were used as interventions and comparators. RESULTS We included 55 studies, of which 1 study was a meta-analysis, 9 were randomized controlled trials, 21 were prospective studies, and 24 were retrospective studies. Topiramate, levetiracetam, zonisamide, and sodium valproate with benzodiazepine (clonazepam or nitrazepam) were found to be potential drugs for treating West syndrome besides adrenocorticotropic hormone, steroids, and vigabatrin. Ketogenic diet and modified Atkins diet were also found to be effective. CONCLUSIONS To date, data regarding the efficacy of treatments of West syndrome still remain limited. Some treatments, including topiramate and ketogenic diet, seem promising besides adrenocorticotropic hormone, steroids, and vigabatrin. Well-designed trials are warranted to validate the findings.
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Khatun Z, Choi YS, Kim YG, Yoon K, Nurunnabi M, Li L, Lee E, Kang HC, Huh KM. Bioreducible Poly(ethylene glycol)-Triphenylphosphonium Conjugate as a Bioactivable Mitochondria-Targeting Nanocarrier. Biomacromolecules 2017; 18:1074-1085. [PMID: 28257184 DOI: 10.1021/acs.biomac.6b01324] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bioactivable nanocarrier systems have favorable characteristics such as high cellular uptake, target specificity, and an efficient intracellular release mechanism. In this study, we developed a bioreducible methoxy polyethylene glycol (mPEG)-triphenylphosphonium (TPP) conjugate (i.e., mPEG-(ss-TPP)2 conjugate) as a vehicle for mitochondrial drug delivery. A bioreducible linkage with two disulfide bond-containing end groups was used at one end of the hydrophilic mPEG for conjugation with lipophilic TPP molecules. The amphiphilic mPEG-(ss-TPP)2 self-assembled in aqueous media, which thereby formed core-shell structured nanoparticles (NPs) with good colloidal stability, and efficiently encapsulated the lipophilic anticancer drug doxorubicin (DOX). The DOX-loaded mPEG-(ss-TPP)2 NPs were characterized in terms of their physicochemical and morphological properties, drug-loading and release behaviors, in vitro anticancer effects, and mitochondria-targeting capacity. Our results suggest that bioreducible DOX-loaded mPEG-(ss-TPP)2 NPs can induce fast drug release with enhanced mitochondrial uptake and have a better therapeutic effect than nonbioreducible NPs.
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Affiliation(s)
| | - Yeon Su Choi
- Department of Pharmacy, Integrated Research Institute of Pharmaceutical Sciences, and BK21 PLUS Team for Creative Leader Program for Pharmacomics-based Future Pharmacy, College of Pharmacy, The Catholic University of Korea , 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 14662, Republic of Korea
| | | | | | | | | | | | - Han Chang Kang
- Department of Pharmacy, Integrated Research Institute of Pharmaceutical Sciences, and BK21 PLUS Team for Creative Leader Program for Pharmacomics-based Future Pharmacy, College of Pharmacy, The Catholic University of Korea , 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 14662, Republic of Korea
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Matsuura R, Hamano SI, Hirata Y, Oba A, Suzuki K, Kikuchi K. Intravenous immunoglobulin therapy is rarely effective as the initial treatment in West syndrome: A retrospective study of 70 patients. J Neurol Sci 2016; 368:140-4. [PMID: 27538618 DOI: 10.1016/j.jns.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate factors influencing the efficacy and safety of intravenous immunoglobulins (IVIG) therapy for West syndrome. METHODS We investigated seizure outcomes in 70 patients who received IVIG treatment for West Syndrome during the first 3months after the onset of epileptic spasms. IVIG was administered for 3 consecutive days (initial IVIG treatment) at dosages ranging from 100 to 500mg/kg/day. If spasms disappeared within 2weeks of the initial treatment, maintenance IVIG treatment was commenced. We evaluated seizure outcomes at 2weeks (initial evaluation), at 2years (long-term evaluation), and the last visit (last follow-up evaluation) after the initial IVIG treatment. We analyzed dosages of IVIG, age at onset of spasms, treatment lag, and etiologies between responders and non-responders. RESULTS Among the patients, 7/70 (10.0%) had cessation of spasms and resolution of hypsarrhythmia at the initial evaluation. Another 6/70 patients (8.6%) were found to have cessation of spasms at the long-term evaluations. The treatment lag in responders was shorter than that in non-responders (P<0.01). There were no significant differences between responders and non-responders in IVIG dosages, age at onset of spasms, and etiologies. Two patients had relapse of partial seizures after cessation of spasms at the last follow-up evaluation. Adverse effects occurred in 2/70 patients. CONCLUSIONS The efficacy of IVIG was so low that it should not be considered as first-line treatment in West syndrome. IVIG therapy has a good safety profile and we would recommend it for West syndrome cases with drug resistance, severe complications associated with profound brain damage, severe brain atrophy, and in immunocompromised patients.
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Affiliation(s)
- Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 2100, Magome, Iwatsuki-ku, Saitama-city, Saitama, 339-8551, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 2100, Magome, Iwatsuki-ku, Saitama-city, Saitama, 339-8551, Japan.
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, 2100, Magome, Iwatsuki-ku, Saitama-city, Saitama, 339-8551, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Atsuko Oba
- Division of Neurology, Saitama Children's Medical Center, 2100, Magome, Iwatsuki-ku, Saitama-city, Saitama, 339-8551, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Kotoko Suzuki
- Division of Neurology, Saitama Children's Medical Center, 2100, Magome, Iwatsuki-ku, Saitama-city, Saitama, 339-8551, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, 2100, Magome, Iwatsuki-ku, Saitama-city, Saitama, 339-8551, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Kubota K, Kinomura Y, Yamamoto T, Ozeki M, Kawamoto M, Kawamoto N, Fukao T. ACTH therapy for West syndrome with severe hemophilia A. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 6:1-2. [PMID: 27896066 PMCID: PMC5118558 DOI: 10.1016/j.ebcr.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/30/2016] [Indexed: 11/20/2022]
Abstract
Hemophilia A is an X-linked recessive disorder caused by factor VIII deficiency, which is an important factor in the coagulation system. Here, we describe a 1-year-old boy with hemophilia A who developed West syndrome (WS). Recombinant factor VIII was administered during adrenocorticotropic hormone (ACTH) therapy to prevent intracranial hemorrhage. Infusion of factor VIII at fixed intervals is useful for the safe administration of ACTH therapy for patients with WS with severe hemophilia A. A coagulation screening test should be performed before ACTH therapy.
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Affiliation(s)
- Kazuo Kubota
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoriko Kinomura
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takahiro Yamamoto
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Minako Kawamoto
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Norio Kawamoto
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toshiyuki Fukao
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
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Relationship between initial electroencephalographic characteristics and seizure outcomes in children with non-lesional West syndrome. Epilepsy Res 2015; 110:49-54. [PMID: 25616455 DOI: 10.1016/j.eplepsyres.2014.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/16/2014] [Accepted: 11/19/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND To characterize the initial interictal electroencephalography (EEG) activities associated with seizure outcomes in children with non-lesional West syndrome (WS), and their worth in the prediction of seizure-free (SF) vs no seizure-free (No-SF) outcomes. METHODS We retrospectively reviewed the initial scalp EEGs for at least a 40-min duration, and the medical records of 66 children who were diagnosed as WS with normal MRI, and who were followed-up with for 4.5 ± 2.1 years. We assessed the following clinical and EEG findings: onset of seizures, development, underlying etiologies, initial interictal EEGs, and seizure evolution. These variables were compared between two groups: SF vs No-SF groups. RESULTS In total, 36 (54.5%) children had SF outcomes and 30 (45.5%) had No-SF outcomes during long-term follow-up (4.4 ± 2.3 vs 4.6 ± 2.0 years, p = 0.7644). The mean age at seizure onset was similar in the SF and No-SF groups (6.0 ± 3.0 vs 6.9 ± 3.2 months, p = 0.2443). Delayed development before the onset of spasms was similarly observed in both groups (13.9% vs 13.3%). Initial EEG findings significantly differed with typical hypsarrhythmia (41.7% vs 73.3%, p = 0.0098), multiple independent spike foci (MISF) (55.6% vs 83.3%, p = 0.0158), frontal-dominant MISF (0.0% vs 40.0%, p < 0.0001), and frontal-dominant generalized epileptiform discharges (EDs) (0.0% vs 16.7%, p=0.0108) being involved more infrequently in the SF group than in the No-SF group, respectively. Patients in the SF group showed no frontal-dominant MISF or frontal-dominant generalized EDs, and a more often normal to borderline sleep-spindle (83.3% vs 40.0%, p = 0.0002) than the No-SF group. CONCLUSION Patients with SF outcomes more frequently showed the posterior-dominant generalized EDs and normal to borderline sleep-spindle, and the No-SF group more often had typical hypsarrhythmia, frontal-dominant MISF, frontal-dominant generalized EDs, and no normal sleep-spindle. Initial interictal EEG findings may predict seizure outcomes in patients with non-lesional WS.
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Effect of adrenocorticotropic hormone therapy for epileptic spasms developing after the age of 1 year. Seizure 2014; 23:521-6. [PMID: 24768270 DOI: 10.1016/j.seizure.2014.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Epileptic spasms sometimes begin after the first year of life, and such seizures are recognized as late-onset spasms (LOS). The prognosis of LOS is poor, and a treatment strategy has not been established. This study aimed to assess the short- and long-term effects of adrenocorticotropic hormone (ACTH) therapy for LOS. METHODS We investigated the rate of LOS in 22 patients (14 boys and 8 girls) treated with ACTH therapy. The age at onset of LOS and at the start of ACTH therapy ranged from 12 to 94 months (median, 31.6 ± 22.1 months) and from 12.5 to 116 months (median, 37.5 ± 23.7 months), respectively. We investigated the response rate of LOS treated with ACTH therapy, and compared the clinical features between responders (short-term) and nonresponders. RESULTS Nine (41%) of the 22 patients showed cessation of epileptic spasms within 3 months. The epileptic spasms ceased in four of these nine patients for more than 1 year. The age at onset of LOS was significantly associated with short-term seizure cessation (p<0.05). Patients who achieved short-term cessation of seizures received ACTH therapy within 6 months from the onset of LOS. CONCLUSION ACTH therapy is a potentially effective treatment when started within 6 months from the onset of LOS. A younger age at onset of LOS is associated with a favorable outcome.
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Shumiloff NA, Lam WM, Manasco KB. Adrenocorticotropic hormone for the treatment of West Syndrome in children. Ann Pharmacother 2013; 47:744-54. [PMID: 23606552 DOI: 10.1345/aph.1r535] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the current literature on the efficacy and safety of low- versus high-dose adrenocorticotropic hormone (ACTH) regimens, low-dose ACTH regimens, and comparison of ACTH with oral corticosteroids or vigabatrin for the treatment of West syndrome. DATA SOURCES A literature search was performed using MEDLINE, PubMed, and Inter national Pharmaceutical Abstracts (1975-November 2012) to identify studies for inclusion. In addition, reference citations from identified publications were reviewed. The following search terms were used: infantile spasms, West syndrome, adrenocorticotropic hormone, corticotropin, symptomatic West syndrome, cryptogenic West syndrome, pediatric, children, infant, adolescent, and neonate. STUDY SELECTION AND DATA EXTRACTION Studies included in this article evaluated low-dose versus high-dose ACTH, low-dose ACTH, and ACTH compared with vigabatrin and oral corticosteroids. Data reporting the efficacy and adverse effects of ACTH, vigabatrin, and oral corticosteroids were extracted from each publication. Only English-language publications were included. We initially reviewed 20 studies, and 14 were included: 5 prospective randomized clinical trials and 9 chart reviews. DATA SYNTHESIS West syndrome is an age-specific epileptic disorder that occurs in infancy and early childhood. It is characterized by the triad of infantile spasms, neurodevelopmental regression or delay, and hypsarrhythmia on electroencephalogram (EEG). The efficacy and adverse events of ACTH with different dosage regimens were reviewed and analyzed. ACTH compared with vigabatrin and oral corticosteroids was also evaluated. Based on this review, low-dose ACTH is probably as effective as high-dose ACTH. Compared with other agents, ACTH is suggested to be more effective than oral corticosteroids, and compared with vigabatrin, it has improved outcomes in the cessation of spasms. However, studies evaluating the efficacy of ACTH are limited by small sample size, inconsistent dosage regimens, and the use of synthetic or natural ACTH products. Serious adverse events, including intracranial hemorrhage, brain atrophy, Cushing syndrome, infection, weight gain, and hypertension, may deter the use of ACTH. Short-term therapy is recommended to reduce the risk of adverse effects. CONCLUSIONS The current literature suggests that short-term, low-dose ACTH should be considered first-line treatment of infantile spasms.
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Affiliation(s)
- Nicole A Shumiloff
- College of Pharmacy, University of Georgia, Georgia Health Sciences Medical Center, Augusta, GA, USA.
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Abstract
Infantile spasms are a unique disorder of infancy and early childhood. The average age at onset of infantile spasms is 6 months and the average incidence of the disorder is approximately 0.31 per 1000 live births. Approximately one-quarter of patients will spontaneously stop having spasms within 1 year of onset. There are three main types of epileptic spasms: flexor, extensor, and mixed flexor-extensor. Spasms frequently occur in clusters and commonly occur upon arousal from sleep. The motor spasms are frequently confused with other normal and abnormal infant behaviors. Typically, the interictal EEG reveals hypsarrhythmia or one of its variants. A variety of ictal EEG patterns may be seen, the most common of which is a generalized slow-wave transient followed by an attenuation of the background activity in all regions. The primary treatment objective is to improve the EEG and stop the spasms as soon as possible and to avoid prolonged treatment durations with any form of therapy. Currently, there is no conclusive evidence that medical or surgical treatment of infantile spasms significantly alters long-term outcome. Although the pathophysiological mechanism underlying infantile spasms is unknown, several animal models of infantile spasms have been developed in recent years.
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Affiliation(s)
- Richard A Hrachovy
- Peter Kellaway Section of Neurophysiology, Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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Olivetti PR, Noebels JL. Interneuron, interrupted: molecular pathogenesis of ARX mutations and X-linked infantile spasms. Curr Opin Neurobiol 2012; 22:859-65. [PMID: 22565167 DOI: 10.1016/j.conb.2012.04.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 04/09/2012] [Indexed: 11/17/2022]
Abstract
X-linked Infantile Spasms Syndrome (ISSX) is a catastrophic epilepsy of early childhood with intractable seizures, intellectual disability, and poor prognosis. A spectrum of mutations in the Aristaless-Related Homeobox gene (ARX) has been linked to ISSX, and downstream targets of this interneuron-expressed transcription factor are being defined. Recent advances combining in vitro and in vivo methods have unveiled complex interactions between Arx and its binding partners and their effects on cell migration and maturation that can help explain the diversity of ARX phenotypes. New mutant mouse models of Arx-induced pathology, including a recent human triplet-repeat expansion mutation with a phenotype of infantile spasms and electrographic seizures, provide valuable tools for exploring the pathophysiology of Arx and substrates for testing novel therapies.
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Affiliation(s)
- Pedro R Olivetti
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, United States
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A prospective study on the treatment of infantile spasms with first-line topiramate followed by low-dose ACTH. Epilepsy Res 2011; 93:149-54. [DOI: 10.1016/j.eplepsyres.2010.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 09/07/2010] [Accepted: 12/07/2010] [Indexed: 11/20/2022]
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Komoike Y, Shimojima K, Liang JS, Fujii H, Maegaki Y, Osawa M, Fujii S, Higashinakagawa T, Yamamoto T. A functional analysis of GABARAP on 17p13.1 by knockdown zebrafish. J Hum Genet 2010; 55:155-62. [PMID: 20111057 DOI: 10.1038/jhg.2010.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Array-based comparative genomic hybridization identified a 2.3-Mb microdeletion of 17p13.2p13.1 in a boy presenting with moderate mental retardation, intractable epilepsy and dysmorphic features. This deletion region was overlapped with the previously proposed shortest region overlapped for microdeletion of 17p13.1 in patients with mental retardation, microcephaly, microretrognathia and abnormal magnetic resonance imaging (MRI) findings of cerebral white matter, in which at least 17 known genes are included. Among them, DLG4/PSD95, GPS2, GABARAP and KCTD11 have a function in neuronal development. Because of the functional importance, we paid attention to DLG4/PSD95 and GABARAP, and analyzed zebrafish in which the zebrafish homolog of human DLG4/PSD95 and GABARAP was knocked down and found that gabarap knockdown resulted in small head and hypoplastic mandible. This finding would be similar to the common findings of the patients with 17p13.1 deletions. Although there were no pathogenic mutations in DLG4/PSD95 or GABARAP in a cohort study with 142 patients with idiopathic developmental delay with/without epilepsy, further studies would be required for genes included in this region.
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Affiliation(s)
- Yuta Komoike
- International Research and Educational Institute for Integrated Medical Sciences (IREIIMS), Tokyo Women's Medical University, Tokyo, Japan
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Genetic polymorphisms of MC2R gene associated with responsiveness to adrenocorticotropic hormone therapy in infantile spasms. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200809010-00006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Few studies have focused on tolerability and adverse events associated with natural adrenocorticotropic hormone injections for treatment of infantile spasms. Using a retrospective chart review of 130 patients, the authors compare major adverse events, weight and blood pressure changes, and unplanned medication changes associated with adrenocorticotropic hormone (ACTH) injections versus other antiepileptic drugs. Children treated with adrenocorticotropic hormone injections experienced significant short-term weight gain and blood pressure elevations, which were readily reversible with weaning off the drug. Twenty-three percent of patients treated with adrenocorticotropic hormone (14 of 60) and 17% of patients treated with other antiepileptic drugs (11 of 65) experienced a major adverse event during treatment. Few patients overall required a change in medication due to intolerable side effects. Despite early changes in weight and blood pressure, short courses of high-dose natural adrenocorticotropic hormone are generally well tolerated with no increased major adverse events when compared to antiepileptic drugs in the treatment of infantile spasms.
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Affiliation(s)
- Arthur Partikian
- Pediatric Neurology Division, Women's and Children's Hospital, Keck School of Medicine, Los Angeles, California 90033, USA.
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Hamano SI, Yoshinari S, Higurashi N, Tanaka M, Minamitani M, Eto Y. Regional cerebral blood flow and developmental outcome in cryptogenic West syndrome. Epilepsia 2007; 48:114-9. [PMID: 17241217 DOI: 10.1111/j.1528-1167.2006.00899.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To elucidate the relation between alterations of regional cerebral blood flow (rCBF) by adrenocorticotropic hormone (ACTH) therapy and developmental outcomes of cryptogenic West syndrome. METHODS Quantitative measurement of rCBF, with autoradiography method using N-isopropyl-((123)I) p-iodoamphetamine single photon emission computed tomography before and after ACTH therapy, was performed on 17 infants with cryptogenic West syndrome. Regions of interest for rCBF were placed bilaterally in the cerebellum, the thalamus, the caudate nucleus, and the frontal, temporal, and occipital cortices. RCBFs and the alteration ratios calculated from rCBFs before and after ACTH therapy were compared between two groups: the normal and delayed groups, which were divided by developmental outcome at 2 years old. RESULTS RCBFs before the therapy were not different statistically between the normal and delayed groups, and between those groups and the control group also. RCBFs after ACTH therapy of the occipital, thalamic and cerebellar regions were different between the normal and delayed groups (p < 0.05). Alteration ratios were different between the normal and delayed groups, in all of the regions but the frontal region (p < 0.05). CONCLUSIONS This study showed the differences of rCBF response by ACTH therapy between the normal and delayed groups of cryptogenic West syndrome. The difference of rCBF alteration might be associated with maturation of the cerebrovascular system, or influence of corticotropin-releasing hormone regarding the brain-adrenal-axis.
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Affiliation(s)
- Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Magome, Iwatsuki-ku, Saitama, Japan.
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Hamano SI, Yoshinari S, Higurashi N, Tanaka M, Minamitani M, Eto Y. Developmental outcomes of cryptogenic West syndrome. J Pediatr 2007; 150:295-9. [PMID: 17307550 DOI: 10.1016/j.jpeds.2006.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 09/16/2006] [Accepted: 12/05/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To elucidate factors affecting the developmental outcome of cryptogenic West syndrome. STUDY DESIGN Medical records of 32 patients, who were followed-up regularly for more than 1 year, were reviewed for clinical features: treatment lag, electroencephalography findings, and seizure evolution. Those features were compared between the normal outcome group (12 patients) and the delayed outcome group (20 patients). The outcomes were determined at the average age of 8.6 +/- 4.7 years. RESULTS The duration from onset to any treatment of the delayed group was longer than that of the normal group (P < .05). Evolution of electroencephalographic findings showed that paroxysmal discharges reappeared in frontal regions more frequently in the delayed group than in the normal group (P < .05). In the delayed group, other types of seizure except for spasms occurred more commonly than in the normal group (P < .05). More patients of the delayed group evolved to focal epilepsy than those of the normal group (P < .05). CONCLUSIONS Shorter treatment lag might be associated with a favorable outcome in cryptogenic West syndrome. Reappearance of paroxysmal discharges in the frontal regions and evolution to other types of seizure may be associated with undetectable lesions in the frontal regions.
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Affiliation(s)
- Shin-ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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