Table 3 Treatment with oral steroids: Short-term treatment
| Ref. | n | Class | Type of steroid (dose) | Duration of full dose, wk | Total treatment duration, wk | Other Rx |
|---|---|---|---|---|---|---|
| * The study by Baram et al.16 is considered a class I when comparing ACTH vs prednisone but class III study when considering whether either medication was effective in decreasing the number of infantile spasms because it did not contain a placebo-controlled group. | ||||||
| † Results prior to crossover (phase I). | ||||||
| ‡ Short-term outcome at 10 mo. | ||||||
| Rx = treatment; F/U = follow-up; SIS = symptomatic infantile spasms; CIS = cryptogenic infantile spasms; RH = reversal of hypsarrhythmia; NS = not stated; ACTH = adrenocorticotropic hormone; HPT = hypertension; CN = completely normal. | ||||||
| 16 | 14 | I/III* | Prednisone (2 mg/kg) | 2 | 4 | No |
| 15 | ACTH (150 IU/m2) | 2 | 4 | No | ||
| 17† | 12 | II | Prednisone (2 mg/kg) | Variable | Variable | No |
| 12 | ACTH (20 IU/m2) | 6 | 7 | No | ||
| 23‡ | III | Prednisolone (2 mg/kg) | 8 | 20–32 | NS | |
| CIS | 38 | Prednisolone (2 mg/kg) | 8 | 20–32 | NS | |
| SIS | 39 | Prednisolone (2 mg/kg) | 8 | 20–32 | NS | |
| 30 | 12 | III | Prednisone (2 mg/kg) | 6 | 20 | NS |
| 28 | 22 | IV | Prednisone (3 mg/kg) | 4 | 16 | NS |
| Mean F/U, mo | Cessation of spasms, no. (%) | SIS vs CIS, no. (%) | Resolution of hypsarrhythmia, no. (%) | Relapse, no. (%) | Side effects, no. (%) | Time to improved |
| 16.9 | 4 (29) | 3 (30) vs 1 (25) | 4 (29) RH | NS | Nil ceased Rx | 1 wk |
| 15 | 13 (87) | (92) vs (67) | 13 (87) RH | (15) | Nil ceased Rx | 1 wk |
| NS | 4 (33) | NS | 4 (33) RH | 2 (29) | HPT 6 (25), 10 (63) atrophy | 33% w/in 2/52 |
| NS | 5 (42) | NS | 5 (42) RH | (33) | 75% w/in 2/52 | |
| 10 | HPT (10) | NS | ||||
| 10 | 15 (39) | 16 (42) CN | NS | NS | ||
| 10 | 14 (36) | 11 (28) CN | NS | NS | ||
| NS | 3 (25) | NS | 3 (25) | 0 (0) | NS | NS |
| 47 | 13 (59) | NS | 11 (50) CN | 8 (62) | NS | Mean 7 d |