Treatment of infantile spasms in resource limited settings: Arandomized controlled trial

Objective: To compare the outcome of ACTH with oral prednisolone for treatment of infantile spasms. Methodology: This is a randomized controlled trial conducted at department of paediatric neurology, The Children Hospital, Lahore, Pakistan after ethical approval from January 1st 2014 to December 31st 2017. (Four years). Seventy patients with infantile spasms were randomized in two equal groups of 35 patients in each group. Patients in group A received prednisolone and in group B received ACTH. The two groups were compared for the spasms free period. Statistical significant determined by chi-square test (p< 0.05 was taken as significant). Non-probability purposive sampling was used and an inclusion criterion was children up to age of one year with infantile spasms. Exclusion criteria include children who had been previously treated with steroids or ACTH. Seventy patients fulfilling inclusion criteria were enrolled through neurology department of Children Hospital, Lahore. History, informed consent was taken by parents and was divided in two groups by lottery method. All the information was collected on a specially designed proforma. Results: In group A, 29 (83%) patients were spasms free, while in group B, 31 (88%) patients were spasms free. Conclusion: Significant number of patients with IS were spasms free with prednisolone which is very cost effective drug as compared to ACTH. Developing counties should considered this treatment option as a first line therapy.