The levels of tryptophan (TRP) metabolites in the CSF of 8 patients with infantile spasms are reported from the Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki 213, Japan. Concentrations in patients were compared to TRP metabolites in CSF from 20 age matched controls (mean age: 5.8 months). The levels of CSF serotonin, 5-hydroxyindoleacetic acid and kynurenine were significantly lower in infantile spasm patients compared to controls, whereas the levels of CSF 3-hydroxykynurenine was significantly higher in patients. Tryptophan and 5-hydroxytryptophan were not significantly different in patients compared to controls. The CSF was collected before treatment. The findings suggest that infantile spasms are associated with a decrease in serotonergic metabolites. 
COMMENT. Yamamoto H has also found a significant inverse correlation with aging in the CSF neurotransmitters during the neonatal period . Langlais PJ, Wardlow ML, and Yamamoto H report marked increases in 5-hydroxyindoleacetic acid and decreases in kynurenine levels in the CSF of 5 infants whose infantile spasms were eliminated or reduced following treatment with ACTH. The elimination of seizures by ACTH was accompanied by increased serotonin turnover. 
Treatment of infantile spasms with IV gamma-globulins (lg/kg/day, the first 2 days, every 3 weeks, for 6 months) is reported in a prospective study of 23 children from the Unite de Neuropediatrie, Centre Gui de Chauliac, 34059, Montpellier, France . Five patients responded satisfactorily and 15 received no benefit. Deficiencies of IgA in one patient, IgG2 in 3, and IgGl in one showed no correlation with therapeutic results. IV gamma-globulin is recommended only as an auxiliary therapy and not the treatment of choice for infantile spasms.