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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Epilepsy in early childhood has been treated successfully with ACTH. However, side effects were significant due to the stimulation of the adrenal cortex by high doses of ACTH over a long time. It has been suggested, that ACTH does not influence the seizures via the adrenal cortex. Therefore we administered an ACTH fragment (ACTH 4-10) which does not influence the adrenal cortex. Seven children aged between 8 months and 13 1/2 years were treated at least for 3 weeks with doses from 15 mg twice daily to 12 x 30 mg/day. Adrenal stimulation did not occur as proven by normal circadian plasma cortisol levels. However, the EEG regularly repeated, did not show improvements. The frequency of seizure was not reduced. It is concluded that this ACTH fragment (ACTH 4-10) does neither influence the adrenal cortex nor the EEG nor the frequency of seizures in early childhood epilepsy.
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PMID:[Therapeutic trial with a fragment of ACTH (ACTH 4-10) in early childhood epilepsy (author's transl)]. 624 84

A controlled study of 5 patients with infantile spasms was performed to determine the effectiveness of corticotropin (ACTH) treatment. Patients were monitored serially, using a time-synchronized polygraphic and video system. Serum cortisol levels were determined by radioimmunoassay. Four patients showed total cessation of seizures and normalization of the EEG on low-dose ACTH therapy. Two of these patients became hypertensive, requiring discontinuance of ACTH. Serum cortisol levels increased markedly in all patients after initiation of ACTh therapy. There appeared to be no consistent difference in serum cortisol levels between patients receiving 20 units/day of ACTH and those receiving 30 or 40 units/day, and there was no difference in cortisol levels in those patients who became hypertensive and those who did not.
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PMID:A controlled study of ACTH therapy in infantile spasms. 625 55

A follow-up study was made on 200 children (115 boys, 85 girls) who had had infantile spasms, in order to compare their present condition over the age of six years with various prognostic factors. 48 of the children (30 males and 18 females) had died, and all the rest were aged six years or older at the time of final follow-up. 139 of the children had received ACTH therapy: at final follow-up, spasms had ceased in 43.5 per cent, and about the same proportion showed normal physical development; 23 per cent had normal mental development and 15.4 per cent were attending ordinary schools. Complete recovery (normal mental and physical development and attending ordinary schools) was achieved in only 19 cases (9.5 per cent). Of the cryptogenic cases, 44.4 per cent had made a full recovery. The poor prognostic factors for continuing seizures were evolution into other types of fits, relapse of seizures after ACTH therapy, seizures concomitant with spasms, and convulsions before the onset of spasms. Poor prognostic factors for physical development were delayed development before the onset of spasms, neurological abnormalities, PEG abnormality, symptomatic aetiology, neonatal convulsions, low birthweight, perinatal asphyxia and being female. Poor prognostic factors for mental development were delayed development before the onset of spasms, neurological abnormalities, PEG abnormality, prenatal and perinatal aetiology, relapse after initial ACTH therapy, laughing attacks, and evolution into other types of fits. Only in the cryptogenic cases was there significant correlation between the delay in treatment and the long-term prognosis for mental development. Poor prognostic factors for educability were very similar to those for mental development. In spite of conflicting views as to the long-term effects of ACTH, prompt treatment seems to be mandatory, at least in cryptogenic cases of infantile spasms.
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PMID:Long-term prognosis after infantile spasms: a statistical study of prognostic factors in 200 cases. 625 7

In a 4-month-old female with agenesis of the corpus callosum, seizures resembling infantile spasms were observed succeeding tonic-clonic seizures. Interictal EEG revealed hypsarrhythmia with an asynchronous pattern. Overnight sleep polygraphy was performed before, during and after ACTH therapy. The results were as follows: 1) Clinical seizures were observed only before ACTH therapy. The clinical seizures and the ictal discharges without any apparent clinical seizures occurred in all stages of wakefulness, REM sleep and NREM sleep. 2) The clinical seizures first began with the tonic-clonic seizures and were followed by seizures resembling infantile spasms. The seizures resembling infantile spasms did not appear singly. The ictal discharges in the tonic-clonic seizures appeared only in one hemisphere and, moreover, asynchronously on many occasions. The polygram of a seizure resembling infantile spasms was just like that of infantile spasms. 3) Before ACTH therapy, decrease of REM sleep time and lack of slow wave sleep were found. Decrease of REM sleep time, lightening of sleep and prolongation of awake time were observed during ACTH therapy as compared with those before the therapy. It was indicated that the seizures resembling infantile spasms in the present case differed considerably from infantile spasms. In addition, it was suggested that the asynchrony of hypsarrhythmia and the asymmetry of ictal discharges were not attributable to agenesis of the corpus callosum but dysfunction of a lower area than the corpus callosum.
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PMID:Overnight polygraphic study of agenesis of the corpus callosum with seizures resembling infantile spasms. 626 3

Overnight sleep polygrams were recorded before and during therapy in nine patients with infantile spasms. Results showed that ACTH therapy increased the waking time and decreased rapid eye movement sleep. Thus it caused sleep disturbance in patients with infantile spasms. During ACTH therapy the number of rapid eye movements/min and the pulse rate decreased significantly. Body movements/min also decreased, but not significantly. These results suggest that ACTH therapy may inhibit functions of the central nervous system. The respiratory rate increased during ACTH and clonazepam therapy, probably in association with the decrease or the absence of seizures. These findings indicate the necessity for further studies on whether ACTH therapy is really of value in patients with infantile spasms, and show that if ACTH is given, the period of therapy should be as short as possible.
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PMID:Influence of ACTH therapy on overnight sleep polygrams in infantile spasms. 626 70

We investigated the prognostic factors for mental and physical development and seizure control by dividing the subjects into various etiologic groups in 200 patients with infantile spasms, all of whom (except 48 who died) were aged six years or older. The results were as follows: 1) Intermediate (4-12 mos) onset was found to be a favorable prognostic factor for seizure control in cryptogenic cases, although there was no relation between the age of onset and prognosis in other etiologic groups. 2) There was a significant correlation between the treatment lag and long-term prognosis for mental and physical development only in cryptogenic cases. A short treatment lag (0-2 mos) was associated with a good prognosis. All cryptogenic patients who had no relapse after ACTH therapy developed normally, although in symptomatic cases, there was no correlation between the relapse and the outcome.
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PMID:Prognostic factors of infantile spasms from the etiological viewpoint. 627 14

Repeated application of brain stimulation can lead to a progressively augmenting electrical and behavioral response-- a phenomenon termed seizure kindling. In this experiment, stimulation was delivered once per day, and was followed by peripheral (intraperitoneal) administration of ACTH or cortisone. An intermediate or a high dose of either hormone (0.3 IU or 3.0 IU of ACTH/animal, 10 mg or 25 mg cortisone/animal) delayed the completion of kindling if administered shortly after each kindling stimulation. Lower doses (0.03 IU of ACTH or 2 mg of cortisone) had no significant effects. The high dose of ACTH or cortisone was no longer effective if administration was delayed more than 4 h after stimulation. Peripherally administered ACTH and cortisone can influence processes initiated by the brain stimulation which presumably underlie the augmentation of response to successive stimulations. This time-limited action is analogous to the effects of these hormones on memory consolidation.
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PMID:Hormonal influences on seizure kindling: the effects of post-stimulation ACTH or cortisone injections. 627 51

The long-term prognosis of 192 surviving children with the syndrome of infantile spasms was evaluated. The children had been admitted to three paediatric hospitals in Helsinki at the time of initial diagnosis. The aetiological factors of the syndrome were carefully studied in each case. ACTH therapy was employed in 162, usually for about six weeks. The follow-up study 3-19 (mean 10.4) years later was made at the Children's Hospital, University of Helsinki. The rate of mortality was 19.6 per cent. Normal development was seen in 12 per cent and slightly subnormal in 10.4 per cent of the surviving children. Psychiatric disorders were seen in 27.6 per cent of the survivors. Sensory defects were also common. Severe cerebral palsy was seen in 4 per cent. Other seizures after cessation of the infantile spasms were seen in 60 per cent. Serial EEG studies showed that the temporal lobe was the most common site of abnormality. Abnormalities in the temporal lobes were seen frequently in children with symptomatic neonatal hypoglycaemia as a probable cause of the spasms. Prognostically favourable factors were "idiopathic" aetiology, normal development and not other fits prior to the spasms, short treatment lag, good response to ACTH and short duration of the spasms. In this study early treatment seemed to be of great importance even with regard to mental development. The factors connected with a bad outcome were: symptomatic aetiology (especially brain malformations, early infections and tuberous sclerosis), slow development before spasms, other seizures before infantile spasms, early onset of the spasms, long treatment lag, long duration of the spasms and other later occurrence of myoclonic-astatic seizures (Lennox-Gastaut). Large doses of ACTH (120-160 units) were not associated with a better prognosis than the smaller doses (20-40 units). The benefit of long versus short treatment schedules could not be evaluated in this study. The relapse rate here was 32 per cent.
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PMID:A long-term follow-up study of 214 children with the syndrome of infantile spasms. 628 79

We report on two infants (two and six month old) with infantile myoclonic seizures, who developed signs of hypertrophic cardiomyopathy (HCM), while receiving ACTH treatment (Tetracosactid=Synacthen Depot). The diagnosis of HCM was established by echocardiography. The first patient (R.M. female). showed signs of cardiac insufficiency and was treated with a beta-blocking agent (Propranolol=Dociton). This led to resolution of the clinical symptoms and reversal of myocardial muscle thickness as determined by echocardiography. The second patient (R.S. female) did not develop cardiac symptoms. A correlation between cardiomyopathy and ACTH treatment is discussed. Based on the various biological effects of ACTH different hypothetical explanations for this correlation are proposed: increased deposition of glycogen, enhanced protein synthesis, oedema of the myocardial tissue and systemic hypertension. Because of the correlation observed between ACTH treatment and the development of cardiomyopathy we recommend regular physical and echocardiographic examinations to detect cardiac involvement during treatment with ACTH.
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PMID:[Hypertrophic cardiomyopathy during ACTH treatment]. 630 97

We treated 116 children with ACTH or prednisone. Fifty-two had infantile spasms with hypsarhythmia, and 64 had other types of intractable seizures. ACTH completely controlled seizures in all patients with infantile spasms and hypsarhythmia and 74% of those with other types of seizures. Prednisone controlled 51% of patients with infantile spasms and none with other seizures. Serious side effects were minimal for both drugs, and recurrent seizures occurred in 40 to 50% of patients within 4 to 14 months after completion of therapy.
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PMID:ACTH and prednisone in childhood seizure disorders. 630 15


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