Response to magnesium sulfate and adrenocorticotropic hormone combination therapy for infantile spasms with failed first‐line treatments

ABSTRACT Importance Infantile spasm (IS) is a kind of refractory epilepsy. The first‐line treatments for IS are adrenocorticotropic hormone (ACTH), oral corticosteroids, and vigabatrin. Objective This study aimed to evaluate the efficacy of magnesium sulfate and ACTH (MgSO4+ACTH) combination therapy in patients with IS who failed first‐line treatments. Methods In this retrospective study, the clinical data of patients with IS who failed first‐line treatments were collected in the Chinese PLA General Hospital. Patients received MgSO4+ACTH combination therapy after first‐line treatments failed. The course of treatments was 2 weeks. The therapeutic dose of ACTH and MgSO4 was 2.5 U·kg−1·d−1 and 0.25 g·kg−1·d−1, respectively. Results A total of 229 patients with IS who failed the first‐line treatments were collected. At the end of the MgSO4+ACTH combination treatment, the seizure‐free rate was 48.5% (111/229), and the resolution of hypsarrhythmia on electroencephalogram (EEG) was 72.1% (165/229). About 21.4% (49/229) of patients showed side effects, including infectious diseases, hypokalemia, and diarrhea. Interpretation For patients with IS who failed first‐line treatments, in terms of the seizure‐free rate and resolution of hypsarrhythmia on EEG, MgSO4+ACTH combination therapy can be considered.