Langlais P J, Wardlow M L, Yamamoto H
Department of Psychology, San Diego State University, CA 92182.
Pediatr Neurol. 1991 Nov-Dec;7(6):440-5. doi: 10.1016/0887-8994(91)90028-j.
Cerebrospinal fluid (CSF) from 7 patients with infantile spasms (mean age: 6.7 months) was collected before and after treatment with adrenocorticotropic hormone (ACTH). The concentration of neurotransmitter metabolites was analyzed using high-performance liquid chromatography and compared to the metabolite concentration in the CSF from 7 age-matched controls (mean age: 6.1 months). Pretreatment levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid, 3-methoxy-4-hydroxyphenyl glycol (MHPG), and kynurenine were significantly lower in infantile spasm patients compared to controls. Following treatment, marked increases in 5-HIAA and decreases in kynurenine levels were observed in the CSF of the 5 infants whose seizures were eliminated or reduced by ACTH. In the 2 nonresponders 5-HIAA levels decreased. The level of MHPG was reduced slightly in 5 infants, including the 2 nonresponders, and was increased in 2 responders. CSF homovanillic acid levels increased in 4 infantile spasm infants and decreased in 3 following ACTH. These data demonstrate that the presence of seizures in infantile spasms is associated with a significant decrease in serotonergic activity and that elimination of seizures by ACTH is accompanied by increased serotonin turnover. The simultaneous increase of 5-HIAA and decrease of kynurenine, an alternate metabolite of tryptophan, suggests an underlying disturbance of tryptophan metabolism in infantile spasms. The possibility that elimination of seizures by ACTH may be related to decreased production of certain kynurenine metabolites, particularly quinolinic acid, is discussed.
收集了7例婴儿痉挛症患者（平均年龄：6.7个月）在促肾上腺皮质激素（ACTH）治疗前后的脑脊液（CSF）。使用高效液相色谱法分析神经递质代谢物的浓度，并与7名年龄匹配的对照者（平均年龄：6.1个月）的脑脊液中代谢物浓度进行比较。与对照组相比，婴儿痉挛症患者脑脊液中5-羟吲哚乙酸（5-HIAA）、高香草酸、3-甲氧基-4-羟基苯乙二醇（MHPG）和犬尿氨酸的预处理水平显著降低。治疗后，在5例经ACTH治疗后癫痫发作消除或减少的婴儿的脑脊液中，观察到5-HIAA显著增加，犬尿氨酸水平降低。在2例无反应者中，5-HIAA水平下降。包括2例无反应者在内的5例婴儿的MHPG水平略有降低，2例有反应者的MHPG水平升高。4例婴儿痉挛症婴儿的脑脊液高香草酸水平在ACTH治疗后升高，3例降低。这些数据表明，婴儿痉挛症中癫痫发作的存在与血清素能活性的显著降低有关，而ACTH消除癫痫发作伴随着血清素周转率的增加。5-HIAA的同时增加和色氨酸的替代代谢物犬尿氨酸的减少表明婴儿痉挛症中色氨酸代谢存在潜在紊乱。讨论了ACTH消除癫痫发作可能与某些犬尿氨酸代谢物，特别是喹啉酸的产生减少有关的可能性。
