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US neurologists agree on protocols for treatment of infantile spasms
Date:9/2/2010

the University of Kuopio in Finland, said in her commentary, "The goals of the ISWG are certainly worthwhile, but it should be appreciated that treatment approaches differ in Europe from the protocols described in this U.S. perspective." In Europe there are differing opinions on first-line treatment options for IS. After two weeks of VGB therapy, seizure freedom was seen in 26% of patients (Granstrm et al., 1999), 23% of patients (Elterman et al., 2000), and 54% of patients (Lux et al., 2004). In the first two of these studies, the number of IS patients who were seizure-free increased to roughly 65% after 3 months. "These data suggested the response with VGB comes later than with ACTH," Dr. Riikonen stated.

In Japan, treatment strategies for IS also differ from the recommended U.S. protocols. "The dosage of ACTH administered in Japan is strikingly different than prescribed amounts in the U.S.," commented Yukio Fukuyama, M.D., Ph.D., from the Child Neurology Institute in Tokyo, Japan in his commentary on the study by Pellock et al. A 6-month old infant with 8 kg body weight and 0.4 m2 body surface, would be administered a daily dose of ACTH of 60 IU/day (0.6 mg/day) in the U.S. versus 5 IU/day (0.05 mg/day) in Japan. The dosage difference between the U.S. and Japan is likely due to the different preparation forms (simple natural vs. prolonged synthetic). "Despite this large difference in dosage, the rate of seizure disappearance and EEG amelioration appears to be similar. Since the introduction of this low dosage scheme in Japan, it has been rare to observe serious side effects of ACTH (e.g., obesity, hypertension, hypertrichosis, electrolyte imbalance, manifest immunodepression, cardiac dilation, brain shrinkage on CT/MRI) in our daily practice," noted Dr. Fukuyama. VGB is currently not commercially available in Japan.

Oliver Dulac, M.D. and colleagues stated in their commentary, "Pellock et al. provide an excellent overview of IS in t
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Contact: Dawn Peters
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781-388-8408
Wiley-Blackwell
Source:Eurekalert

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