Abstracts

Because the exact mechanism for infantile spasms is yet unknown, there is no treatment deemed most effective. The current standard is adrenocorticotropic hormone (ACTH). The optimal ACTH regimen, dose and duration, is unknown. A clinic visit or hospital admission is usually required to initiate ACTH and home nursing visits are common due to the risk of serious adverse drug reactions (ADRs). It is administered as an intramuscular injection, making it a comparatively expensive drug. The ADRs of ACTH can be severe and even life-threatening. Some examples are edema, hypertension, diabetes, electrolyte disturbances, osteoporosis, muscle wasting, and gastrointestinal ulcers. Because of the high costs and risk of serious ADRs, clinicians have tried other therapies. Conventional anti-epileptic drugs have been used with little or no success. In this retrospective chart review, the combination of Topiramate, Pyridoxine, and Hydrocortisone (TPH), chosen for its efficacy, safety profile, and low cost, will be compared to ACTH. A retrospective chart review of the last five cases of infantile spasms was conducted at both Hennepin County Medical Center (HCMC) and Fairview University Medical Center (FUMC) in Minneapolis, Minnesota. Patients at HCMC used TPH. Patients at FUMC used ACTH. It was an IRB-approved, non-blinded, non-randomized, controlled case series. Birth history, symptoms and age at diagnosis, neurological or causative disease, seizure control, hospitalizations, ADRs, developmental progress, and EEG changes were collected from each group. All patients experienced a decrease in seizure severity. 2 out of 5 ACTH patients acheived temporary cessation, but had seizure recurrence. 4 out of 5 TPH patients acheived seizure cessation and 3 of those had seizure recurrence. The average number and duration of hospitalizations were 1.8 times and 4.7 days for the ACTH group and 1.4 times and 3 days for the TPH group. ADRs were experienced in 3 of the 5 ACTH patients and 1 of the 5 TPH patients. Ambulatory, social, and verbal development, and EEG results were quite similar between the groups. TPH seems to have better outcomes concerning seizure reduction and ADRs. The number of patients studied was too small for statistical analysis, so the differences may not be statistically significant. When convenience, specifically the cost, is examined, TPH seems to be the less expensive alternative with a lower drug cost, decreased observed number of hospitalization admissions and shorter hospital durations. No in-patient admission is required for the initiation of the TPH combination treatment, nor did the side effects require a hospital stay. Since TPH performed better in efficacy, safety, and cost, it seems that TPH may be the more favorable choice.