[P3-44] ACTH induced nonconvulsive status epilepticus in an infant with West Syndrome
Introduction: While adrenocorticotropic hormone (ACTH) is one of the most effective drugs against West syndrome, there have been a few reports describing seizures induced by ACTH.
Methods and Patients: We describe a case of West syndrome with nonconvulsive status epilepticus ( NCSE) induced by ACTH therapy. The patient was a 4- year- old girl. At 7 months of age, she developed infantile spasms. Her electroencephalogram (EEG) showed hypsarrhythmia, so we diagnosed her with West syndrome and treated her with vitamin B6, valproic acid and ACTH (0.01mg/kg/day). Five days after the start of ACTH therapy, her tonic spasms had nearly disappeared. However, from day 5 she began to move slowly and seemed in a dazed semi-conscious state. Her EEG showed continuous spikes & waves in both occipital regions. We diagnosed her ACTH- induced NCSE and stopped ACTH treatment. After discontinuation of the therapy, her NCSE improved. She still had tonic spasms 5-10 times a day, so Zonisamide was added to treatments. After that, there were no seizures for three years.
Conclusions: When patients show activity loss or a semi-conscious state under the influence of ACTH, we should consider the possibility of ACTH- induced NCSE and perform long-time EEG monitoring.
Methods and Patients: We describe a case of West syndrome with nonconvulsive status epilepticus ( NCSE) induced by ACTH therapy. The patient was a 4- year- old girl. At 7 months of age, she developed infantile spasms. Her electroencephalogram (EEG) showed hypsarrhythmia, so we diagnosed her with West syndrome and treated her with vitamin B6, valproic acid and ACTH (0.01mg/kg/day). Five days after the start of ACTH therapy, her tonic spasms had nearly disappeared. However, from day 5 she began to move slowly and seemed in a dazed semi-conscious state. Her EEG showed continuous spikes & waves in both occipital regions. We diagnosed her ACTH- induced NCSE and stopped ACTH treatment. After discontinuation of the therapy, her NCSE improved. She still had tonic spasms 5-10 times a day, so Zonisamide was added to treatments. After that, there were no seizures for three years.
Conclusions: When patients show activity loss or a semi-conscious state under the influence of ACTH, we should consider the possibility of ACTH- induced NCSE and perform long-time EEG monitoring.