Arya Ravindra, Shinnar Shlomo, Glauser Tracy A
Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
J Child Neurol. 2012 Oct;27(10):1284-8. doi: 10.1177/0883073812453203. Epub 2012 Aug 1.
Adrenocorticotropic hormone (ACTH) and corticosteroids are the usual first-line treatment options for infantile spasms. Despite significant differences, these agents are often lumped together in this context. There is a need to systematically explore the efficacy of corticosteroids in the treatment of infantile spasms, especially in comparison to ACTH. This review identified and analyzed corticosteroid clinical trials and summarized their short-term efficacy and tolerability. Primary outcome was cessation of spasms and abolition of hypsarrhythmia on prolonged video electroencephalographic monitoring. Eight corticosteroid clinical trials were found with only 2 fulfilling the criteria for adequate design. The weighted-mean efficacy of corticosteroids to achieve primary outcome was 31% for these 2 methodologically adequate studies. Including reanalyzed data from 3 other studies, the corticosteroid efficacy was found to be 42%. On the basis of the available evidence, the efficacy of high-dose corticosteroids is similar to low-dose ACTH and inferior to high-dose ACTH, the current standard treatment.
促肾上腺皮质激素（ACTH）和皮质类固醇是婴儿痉挛症常用的一线治疗选择。尽管存在显著差异，但在这种情况下这些药物常被归为一类。有必要系统地探讨皮质类固醇在治疗婴儿痉挛症方面的疗效，尤其是与ACTH相比。本综述识别并分析了皮质类固醇的临床试验，并总结了其短期疗效和耐受性。主要结局是在延长的视频脑电图监测中痉挛停止和高度节律失调消失。共发现八项皮质类固醇临床试验，其中只有两项符合设计充分的标准。对于这两项方法学上充分的研究，皮质类固醇实现主要结局的加权平均疗效为31%。纳入另外三项研究重新分析的数据后，发现皮质类固醇的疗效为42%。基于现有证据，高剂量皮质类固醇的疗效与低剂量ACTH相似，但不如高剂量ACTH，而高剂量ACTH是目前的标准治疗方法。
