A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms

Eric H. Kossoff, Erika Finanger, Zahava Turner, John M. Freeman

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Purpose: ACTH is currently the standard first-line therapy for new-onset infantile spasms, but it has significant side effects. We hypothesized the ketogenic diet (KD), previously reported as beneficial for intractable infantile spasms, would have similar efficacy, but better tolerability than ACTH when used first-line. Methods: We conducted a retrospective chart review of all infants started on the KD (n = 13) and high-dose ACTH (n = 20) for new-onset infantile spasms at our institution since 1996. Results: Infants were spasm-free in 8 of 13 (62%) infants treated with the KD within 1 month, compared to 18 of 20 (90%) treated initially with ACTH, p = 0.06. When effective, median time to spasm freedom was similar between ACTH and the KD (4.0 vs. 6.5 days, p = 0.18). Those treated with ACTH were more likely to have a normal EEG at 1 month (53% vs. 9%, p = 0.02), however, use of the KD led to EEG normalization within 2-5 months in all eight who became spasm-free. In the five children in whom the KD was unsuccessful, four became spasm-free subsequently with ACTH or topiramate immediately. Side effects (31% vs. 80%, p = 0.006) and relapse rate after initial success (12.5% vs. 33%, p = 0.23) were lower with the KD. Discussion: In this retrospective study, the KD stopped spasms in nearly two-thirds of cases, and had fewer side effects and relapses than ACTH. ACTH normalized the EEG more rapidly, however. Further prospective study of the KD as, with a 2-week time limit if unsuccesful, first-line therapy for infantile spasms is warranted.

Original languageEnglish (US)
Pages (from-to)1504-1509
Number of pages6
JournalEpilepsia
Volume49
Issue number9
DOIs
StatePublished - Sep 2008
Externally publishedYes

Fingerprint

Ketogenic Diet
Infantile Spasms
Adrenocorticotropic Hormone
Spasm
Electroencephalography
Recurrence
Retrospective Studies
Prospective Studies

Keywords

  • ACTH
  • Hypsarrhythmia
  • Infantile spasms
  • Ketogenic diet

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms. / Kossoff, Eric H.; Finanger, Erika; Turner, Zahava; Freeman, John M.

In: Epilepsia, Vol. 49, No. 9, 09.2008, p. 1504-1509.

Research output: Contribution to journalArticle

Kossoff, Eric H. ; Finanger, Erika ; Turner, Zahava ; Freeman, John M. / A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms. In: Epilepsia. 2008 ; Vol. 49, No. 9. pp. 1504-1509.
@article{b22335f81ffe43c785a71bdffa419d25,
title = "A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms",
abstract = "Purpose: ACTH is currently the standard first-line therapy for new-onset infantile spasms, but it has significant side effects. We hypothesized the ketogenic diet (KD), previously reported as beneficial for intractable infantile spasms, would have similar efficacy, but better tolerability than ACTH when used first-line. Methods: We conducted a retrospective chart review of all infants started on the KD (n = 13) and high-dose ACTH (n = 20) for new-onset infantile spasms at our institution since 1996. Results: Infants were spasm-free in 8 of 13 (62{\%}) infants treated with the KD within 1 month, compared to 18 of 20 (90{\%}) treated initially with ACTH, p = 0.06. When effective, median time to spasm freedom was similar between ACTH and the KD (4.0 vs. 6.5 days, p = 0.18). Those treated with ACTH were more likely to have a normal EEG at 1 month (53{\%} vs. 9{\%}, p = 0.02), however, use of the KD led to EEG normalization within 2-5 months in all eight who became spasm-free. In the five children in whom the KD was unsuccessful, four became spasm-free subsequently with ACTH or topiramate immediately. Side effects (31{\%} vs. 80{\%}, p = 0.006) and relapse rate after initial success (12.5{\%} vs. 33{\%}, p = 0.23) were lower with the KD. Discussion: In this retrospective study, the KD stopped spasms in nearly two-thirds of cases, and had fewer side effects and relapses than ACTH. ACTH normalized the EEG more rapidly, however. Further prospective study of the KD as, with a 2-week time limit if unsuccesful, first-line therapy for infantile spasms is warranted.",
keywords = "ACTH, Hypsarrhythmia, Infantile spasms, Ketogenic diet",
author = "Kossoff, {Eric H.} and Erika Finanger and Zahava Turner and Freeman, {John M.}",
year = "2008",
month = "9",
doi = "10.1111/j.1528-1167.2008.01606.x",
language = "English (US)",
volume = "49",
pages = "1504--1509",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms

AU - Kossoff, Eric H.

AU - Finanger, Erika

AU - Turner, Zahava

AU - Freeman, John M.

PY - 2008/9

Y1 - 2008/9

N2 - Purpose: ACTH is currently the standard first-line therapy for new-onset infantile spasms, but it has significant side effects. We hypothesized the ketogenic diet (KD), previously reported as beneficial for intractable infantile spasms, would have similar efficacy, but better tolerability than ACTH when used first-line. Methods: We conducted a retrospective chart review of all infants started on the KD (n = 13) and high-dose ACTH (n = 20) for new-onset infantile spasms at our institution since 1996. Results: Infants were spasm-free in 8 of 13 (62%) infants treated with the KD within 1 month, compared to 18 of 20 (90%) treated initially with ACTH, p = 0.06. When effective, median time to spasm freedom was similar between ACTH and the KD (4.0 vs. 6.5 days, p = 0.18). Those treated with ACTH were more likely to have a normal EEG at 1 month (53% vs. 9%, p = 0.02), however, use of the KD led to EEG normalization within 2-5 months in all eight who became spasm-free. In the five children in whom the KD was unsuccessful, four became spasm-free subsequently with ACTH or topiramate immediately. Side effects (31% vs. 80%, p = 0.006) and relapse rate after initial success (12.5% vs. 33%, p = 0.23) were lower with the KD. Discussion: In this retrospective study, the KD stopped spasms in nearly two-thirds of cases, and had fewer side effects and relapses than ACTH. ACTH normalized the EEG more rapidly, however. Further prospective study of the KD as, with a 2-week time limit if unsuccesful, first-line therapy for infantile spasms is warranted.

AB - Purpose: ACTH is currently the standard first-line therapy for new-onset infantile spasms, but it has significant side effects. We hypothesized the ketogenic diet (KD), previously reported as beneficial for intractable infantile spasms, would have similar efficacy, but better tolerability than ACTH when used first-line. Methods: We conducted a retrospective chart review of all infants started on the KD (n = 13) and high-dose ACTH (n = 20) for new-onset infantile spasms at our institution since 1996. Results: Infants were spasm-free in 8 of 13 (62%) infants treated with the KD within 1 month, compared to 18 of 20 (90%) treated initially with ACTH, p = 0.06. When effective, median time to spasm freedom was similar between ACTH and the KD (4.0 vs. 6.5 days, p = 0.18). Those treated with ACTH were more likely to have a normal EEG at 1 month (53% vs. 9%, p = 0.02), however, use of the KD led to EEG normalization within 2-5 months in all eight who became spasm-free. In the five children in whom the KD was unsuccessful, four became spasm-free subsequently with ACTH or topiramate immediately. Side effects (31% vs. 80%, p = 0.006) and relapse rate after initial success (12.5% vs. 33%, p = 0.23) were lower with the KD. Discussion: In this retrospective study, the KD stopped spasms in nearly two-thirds of cases, and had fewer side effects and relapses than ACTH. ACTH normalized the EEG more rapidly, however. Further prospective study of the KD as, with a 2-week time limit if unsuccesful, first-line therapy for infantile spasms is warranted.

KW - ACTH

KW - Hypsarrhythmia

KW - Infantile spasms

KW - Ketogenic diet

UR - http://www.scopus.com/inward/record.url?scp=51549092038&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=51549092038&partnerID=8YFLogxK

U2 - 10.1111/j.1528-1167.2008.01606.x

DO - 10.1111/j.1528-1167.2008.01606.x

M3 - Article

VL - 49

SP - 1504

EP - 1509

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 9

ER -