The effects and side-effects of non-depot ACTH therapy in 18 children with infantile spasms are reported from the Wilhelmina Children’s Hospital, University of Utrecht, The Netherlands. In i.m. doses of 0.4 mg bid for 4 weeks, followed by gradual withdrawal over 2 weeks, non-depot ACTH resulted in complete control of spasms and normalization of the EEG in 6 (33%) patients, and a partial control in 5. Those with cryptogenic seizures responded whereas infants with congenital defects, excepting 2 with tuberous sclerosis, were refractory to treatment. Response to non-depot ACTH was comparable to that reported for depot ACTH, the incidence of side-effects was lower, and a persistent hypercortisolism was not induced. [1]

COMMENT. Non-depot ACTH appears worthy of further trial in patients with West syndrome. As with depot ACTH, the dosage schedule may require controlled studies to establish optimal efficacy. Dosage based on surface area or body weight would seem more appropriate, if the mechanism of action is related to a direct effect on the brain, as suggested by these authors and by others. The relatively high frequency of serious side-effects sometimes reported with depot ACTH [2] was associated with a high dose regimen(80-140 IU daily for 6 weeks). I have favored the more conservative regimen with smaller, less toxic doses (10-20 IU daily for 2-3 weeks), a treatment schedule also followed in Japan. [3]