cosyntropin and Epilepsy

Topics: Anticonvulsants; Benzodiazepines; Carbamazepine; Child; Cosyntropin; Electroencephalography; Epilepsy; Frontal Lobe; Humans; Isoxazoles; Life Style; Magnetic Resonance Imaging; Phenytoin; Practice Guidelines as Topic; Temporal Lobe; Valproic Acid; Zonisamide

We assess the effect of acute hypercortisolemia induced by ACTH stimulation on seizures and EEG interictal spike activity in patients with localization-related epilepsy (LRE) and stress-related seizures.. Seven patients (3 males, 4 females) with LRE and stress-related seizures were studied. All patients underwent ACTH stimulation with 0.25-0.75 mg Cosyntropin intravenously at 8 am. Serum cortisol and ACTH levels were monitored half- to one-hourly for 4 to 6 hours. Video/EEG monitoring was also performed.. ACTH injection induced hypercortisolemia in all patients. Hypercortisolemia was not associated with seizures or interictal spike facilitation in any patient. Two patients experienced seizures on the day of ACTH injection, one 8 hours after and another 15 and 12 hours after the injection, during a period when their cortisol levels had returned to normal.. No reproducible interictal EEG changes occurred in any of the patients following ACTH injection.

Topics: Adolescent; Adrenal Cortex Function Tests; Adrenocortical Hyperfunction; Adult; Cosyntropin; Dose-Response Relationship, Drug; Electroencephalography; Epilepsy; Female; Humans; Hydrocortisone; Male; Middle Aged; Seizures; Stress, Physiological; Time Factors

Infantile spasms is a severe infantile seizure disorder that is difficult to treat and has a high morbidity. Absence of spasms on days 13 and 14 after randomisation is more common in infants allocated hormone treatments than in those allocated vigabatrin. We sought to assess whether early control of spasms is associated with improved developmental or epilepsy outcomes.. Infants enrolled in the United Kingdom Infantile Spasms Study (UKISS) were randomly assigned hormone treatment (n=55) or vigabatrin (n=52) and were followed up until clinical assessment at 12-14 months of age. We assessed neurodevelopment with the Vineland adaptive behaviour scales (VABS) at 14 months of age on an intention to treat basis.. Of 107 infants enrolled, five died and 101 survivors reached both follow-up assessments. Absence of spasms at final clinical assessment (hormone 41/55 [75%] vs vigabatrin 39/51 [76%]) was similar in each treatment group (difference 1.9%, 95% CI -18.3% to 14.4%; chi(2)=0.05; p=0.82). Mean VABS score did not differ significantly (hormone 78.6 [SD 16.8] vs vigabatrin 77.5 [SD 12.7]; difference 1.0, 95% CI -4.9 to 7.0; t(99)=0.35, p=0.73). In infants with no identified underlying aetiology, the mean VABS score was higher in those allocated hormone treatment than in those allocated vigabatrin (88.2 [17.3] vs 78.9 [14.3]; difference 9.3, 95% CI 1.2 to 17.3; t(95)=2.28, p=0.025).. Hormone treatment controls spasms better than does vigabatrin initially, but not at 12-14 months of age. Better initial control of spasms by hormone treatment in those with no identified underlying aetiology may lead to improved developmental outcome.

Topics: Adaptation, Psychological; Anti-Inflammatory Agents; Anticonvulsants; Child Development; Cosyntropin; Disease Progression; Epilepsy; Female; Humans; Infant; Infant, Newborn; Male; Prednisolone; Secondary Prevention; Spasms, Infantile; Treatment Outcome; United Kingdom; Vigabatrin

To report a prospectively planned analysis of two randomised controlled trials with embedded comparisons of prednisolone versus tetracosactide depot for the treatment of infantile epileptic spasms syndrome (IESS).. Individual patient data from patients randomly allocated to prednisolone or tetracosactide depot were analysed from two trials (UKISS, ICISS). The comparison was embedded within trials in which some patients also received vigabatrin but only patients receiving monotherapy with randomly allocated hormonal treatments are included in this analysis. The main outcome was cessation of spasms (Days 13-14 after randomisation). Lead time to treatment and underlying aetiology were taken into account. Cessation of spasms on Days 14-42 inclusive, electroclinical response (EEG Day 14), plus developmental and epilepsy outcomes (at 14 months in UKISS and 18 months in ICISS) are also reported. Minimum treatment was prednisolone 40 mg per day for two weeks or tetracosactide depot 0·5 mg IM on alternate days for two weeks, all followed by a reducing dose of prednisolone over two weeks.. 126 infants were included in this study. On tetracosactide depot, 47 of 62 (76%) were free of spasms on Days 13-14 compared to 43 of 64 (67%) on prednisolone (difference 9%, 95% CI -7·2% to +25·2%, chi square 1·15, p = 0·28). For Day 14-42 cessation of spasms, on tetracosactide depot, 41 of 61 (67%) were free of spasms compared to 35 of 62 (56%) on prednisolone (difference 11%, 95% CI -6·4% to +28·4%, chi square 1·51, p = 0·22). There was no significant difference in mean VABS score between infants who received prednisolone compared with those who received tetracosactide depot (74·8 (SD 18·3) versus 78·0 (SD 20·2) t = -0·91 p = 0·36). The proportion with ongoing epilepsy at the time of developmental assessment was 20 of 61 (33%) in the tetracosactide group compared with 26 out of 63 (41%) in the prednisolone group (difference 8%, 95% CI -9·2% to +25·2%, Chi [2] 0·95, p = 0·33).. With hormone monotherapy, either prednisolone or tetracosactide depot may be recommended for infantile epileptic spasms syndrome.

Topics: Anticonvulsants; Cosyntropin; Epilepsy; Humans; Infant; Prednisolone; Randomized Controlled Trials as Topic; Spasm; Spasms, Infantile; Syndrome; Treatment Outcome; Vigabatrin

Topics: Chickenpox; Cosyntropin; Epilepsy; Fatal Outcome; Female; Hormones; Humans; Immunocompromised Host; Infant; Multiple Organ Failure; Tuberous Sclerosis

Hypophysectomized rats showed aberrant and retarded rates of kindled epilepsy. In hypophysectomized rats administered adrenocorticotropic hormone (ACTH) subunits ACTH4-10 and ACTH1-24, the normal kindling pattern was restored. However, in hypophysectomized animals which also had lesions of the thalamus (nucleus parafascicularis), ACTH4-10 did not restore the normal pattern of kindling. There have been many conjectures that kindling may be a subcase of learning. These results are compatible with this hypothesis, since the same procedures act in an analogous fashion within avoidance conditioning paradigms.

Topics: Adrenal Glands; Adrenocorticotropic Hormone; Animals; Behavior, Animal; Cosyntropin; Electroencephalography; Epilepsy; Hypophysectomy; Kindling, Neurologic; Male; Organ Size; Peptide Fragments; Rats; Rats, Inbred Strains; Thalamus

Topics: Adrenocorticotropic Hormone; Child; Child, Preschool; Cosyntropin; Epilepsy; Female; Humans; Hydrocortisone; Infant; Male