RESUMO
The results of neuroradiologic studies of 71 children with infantile spasms treated with ACTH were correlated with the developmental outcome at follow-up (mean 62 months, range 14 to 207 months). Fifty-two (73%) patients had an abnormal NRS on initial evaluation; 49% had cerebral atrophy, 18% had congenital anomalies, and 6% had hydrocephalus. Twenty patients were normal on initial clinical evaluation. At follow-up only the eight (40%) with normal NRS were normal. Twelve (60%) who had unexpected abnormalities on NRS were retarded at follow-up. CAT scanning is necessary to predict the developmental outcome in developmentally normal children with infantile spasm. Eight of nine patients with normal NRS in the early treatment group were developmentally normal at presentation and follow-up. Ten patients who were developmentally normal before spasms began, and had normal NRS but were in the late treatment group, were retarded at initial evaluation and follow-up. This finding suggests that early treatment of children who have a normal NRS and normal development at onset of spasm prevents mental retardation.
Assuntos
Espasmos Infantis/diagnóstico por imagem , Hormônio Adrenocorticotrópico/uso terapêutico , Atrofia , Encéfalo/anormalidades , Encéfalo/patologia , Desenvolvimento Infantil , Seguimentos , Humanos , Lactente , Pneumoencefalografia , Espasmos Infantis/complicações , Espasmos Infantis/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
Fifty-five infants with infantile spasms and hypsarrhythmia, who were treated with ACTH using 80 units im every other day for a mean period of ten months, were studied retrospectively and showed better results than infants using so-called nonsteroidal anticonvulsants or ACTH and steroids in other doses and with other time intervals. The study showed that the treatment with ACTH within the first month of onset of spasms produced a higher incidence of spasm-free state while on treatment, a shorter duration of spasms while on treatment, and a higher incidence of spasm-free state while on treatment, a shorter duration of spasms while on treatment, and a higher incidence of a spasm-free state when off treatment, compared to a similar regimen of ACTH begun after seizures had persusted for more than a month. The value of early treatment of infantile spasms suggests that the treatment of this disease should be regarded as a medical emergency.