Which Therapeutic Approaches to Infantile Spasms Are Effective?

Clinical practice in the most recent studies has tended to proceed from high-dose oral prednisone to very-high-dose therapy, he continued. Outcome data from a study by Hussain et al showed that 63% of patients had a complete response to a very high dose (ie, 8 mg/kg/day and a maximum of 60 mg/day) of oral prednisolone for two weeks. Furthermore, 40% of nonresponders had a complete response to a subsequent two-week course of ACTH.

A similar study showed excellent responses to high-dose (ie, 40 mg/day) prednisolone with an increase to a very high dose (ie, 60 mg/day) if spasms continued, compared with moderate to high doses of synthetic ACTH. Response to very-high-dose prednisolone in this study was 58%. “It’s better than we used to see with 2 mg/kg/day, so very-high-dose prednisolone seems to be better than high-dose prednisolone, but it’s lower than what we’re used to seeing with high-dose ACTH,” said Dr. Wheless. He cited a need for a study comparing a very high dose of prednisolone with high-dose ACTH.

A dose comparison study by Elterman et al in 2010 supported the use of high-dose vigabatrin for infantile spasms. The study had a response rate of about 65%. Patients who did not respond had a much better response to high-dose synthetic ACTH than to high-dose prednisone as a second agent. “If vigabatrin doesn’t work, you might be better off going to a high-dose ACTH as a next step,” said Dr. Wheless.

—Linda Peckel