Pediatric neurologists at the Central Hospital, Aichi Prefectural Colony, Kasugai, Aichi 480-03, Japan, compared the effects of TRH in 31 children and ACTH in 33 with severe epilepsy. Approximately half the cases had infantile spasms and the remainder had Lennox-Gastaut syndrome. In the TRH group, complete control of infantile spasms. occurred in 7 of 13 (53.7%) and marked improvement of the EEG’s was observed in 8 (61.5%). In the ACTH group, infantile spasms were controlled in 75%. TRH treated patients had no serious side-effects whereas 66.7% of the ACTH group had complications, including pneumonia, hypokalemia, cataracts, and brain shrinkage.

TRH-tartrate (TRH-t), 0.5 - 1.0 mg, was administered intravenously to determine immediate effects on seizures and EEG and then intra-muscularly once daily for 1-4 weeks. TRH was effects in controlling infantile spasms within 4-16 days of its initiation. Three of the 7 responders remained seizure-free for > 6 months. [1]

COMMENT: ACTHis effective in the control of infantile spasms and hypsarrhythmia in 50% of cases. The response rate is higher in infants treated early and under one year of age than in those diagnosed later. Hypertension, cushingnoid obesity, congestive heart failure, infection, and cerebral atrophy are some of the more serious side-effects of ACTH therapy. The significant response of infantile spasms to TRH without serious toxicity offers a promising alternative therapy to ACTH. The anticonvulsant action of TRH appears to be central and unrelated to its endocrine action through the pituitary-thyroid axis.