The Effect of Corticotrophin and Prednisolone on Infantile Spasms with Mental Retardation

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Abstract
Twenty-three children with infantile spasms were treated with corticotrophin or prednisolone for at least four weeks. Spasms ceased during treatment in 18 patients but recurred in 13 after treatment. Some eeg improvement occurred in all patients except one, and a non-epileptic record was achieved in nine, though relapse occurred in five of those whose spasms recurred. Eight were given a second course of treatment but seven again relapsed. At the end of an average follow-up period of eight months, 11 patients had no spasms. The effect of corticotrophin was similar to that of prednisolone, although, with the doses employed, corticotrophin appears preferable. No immediate mental improvement occurred, and only two cases eventually achieved a development quotient of 80 or more. Although the drugs had a temporary beneficial effect in both the symptomatic and cryptogenic groups, better results were achieved in the latter group. A comparison is made with a group of patients not treated with hormones and it is concluded that on the whole these drugs have a long-term beneficial effect on the spasms, whereas their effect on mentality is doubtful. It is possible that under hormonal treatment there is an acceleration of the natural changes which occur with age. The mode of action is discussed and recommendations ior treatment are made.