Results of corticotropin treatment of 33 patients with infantile spasms are reported from the Instituto Clinica Pediatrica, Universita di Siena, Italy. The etiology was undetermined in 8 and secondary in 25 (pre- or perinatal distress in 17 and tuberous sclerosis in 2). Pyridoxine 300mg IV tried in all cases initially with EEG monitoring was without effect. ACTH 2 units/kg daily for 10 days followed by alternate day treatment for 10 days with a repeat course in some resulted in improvement in all idiopathic cases (complete in 6) and in 15 secondary cases (complete only in 2). The authors advocate low doses and short courses of ACTH, claiming results comparable with larger amounts (up to 10-12 u/kg/day) for longer periods (3 mos) employed by some. Ibid, Eur J Pediatr 1983;42:51. [1]

COMMENT. The mechanism of the anticonvulsant action of ACTH in infantile spasms is unknown. It is probably independent of the adrenal [2] and a possible direct CNS effect is a reason proposed for the use of high dosage schedules. In agreement with the present study, my own results with smaller doses, 10-20 units daily irrespective of body weight for 20 days, have equalled those reported with higher doses and longer courses, and serious side effects have been avoided.