Response to magnesium sulfate and adrenocorticotropic hormone combination therapy for infantile spasms with failed first-line treatments.

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 (MgSO+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 MgSO+ACTH combination therapy after first-line treatments failed. The course of treatments was 2 weeks. The therapeutic dose of ACTH and MgSO was 2.5 U·kg·d and 0.25 g·kg·d, respectively.

RESULTS

A total of 229 patients with IS who failed the first-line treatments were collected. At the end of the MgSO+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, MgSO+ACTH combination therapy can be considered.