Mytinger John R, Quigg Mark, Taft William C, Buck Marcia L, Rust Robert S
Department of Neurology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
J Child Neurol. 2010 Aug;25(8):948-53. doi: 10.1177/0883073809356107. Epub 2010 Feb 8.
The authors report their experience with intravenous methylprednisolone for the treatment of infantile spasms. A pulse dose of 20 mg/kg intravenous methylprednisolone on each of 3 successive days, followed by a 2-month oral prednisolone taper, led to the rapid remission (range, 2-6 days) of infantile spasms in 5 of 10 (50%) infants. In the subgroup of infants treated within 1 month of onset, 5 of 6 (83%) experienced remission within 6 days. The authors estimate the medication cost of intravenous methylprednisolone with prednisolone taper to be less than $200. In comparison, the cost of a typical course of adrenocorticotropic hormone in the United States can exceed $70,000. Initial treatment with intravenous methylprednisolone and/or oral corticosteroids is a reasonable cost-effective approach to infantile spasms. The lack of serious side effects, low cost, availability, ease of administration, and comparable efficacy suggests that intravenous methylprednisolone merits consideration for study in randomized prospective trials.
作者报告了他们使用静脉注射甲基强的松龙治疗婴儿痉挛症的经验。连续3天每天静脉注射20mg/kg的甲基强的松龙脉冲剂量，随后进行为期2个月的口服强的松龙逐渐减量治疗，10例婴儿中有5例（50%）的婴儿痉挛症迅速缓解（缓解时间为2 - 6天）。在发病1个月内接受治疗的婴儿亚组中，6例中有5例（83%）在6天内缓解。作者估计静脉注射甲基强的松龙并逐渐减量使用强的松龙的药物成本低于200美元。相比之下，美国一个典型疗程的促肾上腺皮质激素成本可能超过70,000美元。静脉注射甲基强的松龙和/或口服皮质类固醇进行初始治疗是一种治疗婴儿痉挛症合理且具有成本效益的方法。缺乏严重副作用、成本低、易于获得、给药方便以及疗效相当，表明静脉注射甲基强的松龙值得在随机前瞻性试验中进行研究。
