در درمان اسپاسم كودكان ACTH مقايسه اثرات نيترازپام و

Comparison the Effects of Nitrazepam and ACTH on Regards to Treatment of Infantile Spasm

Among different epileptic syndromes, infantile spasms (I.S.) or west syndrome is considered as the most malignant one, which causes irreparable brain damage in the child. Consequently the longer this type of epilepsy lasts, the more harmful results will follow. Knowing this fact, caretaker physician should consider controlling this type of epilepsy with the most important priority. The victims of I.S. are children younger than one year of age, only 5 percent of cases are reported in the age groups or above one year. Currently common treatments include drugs such as ACTH, prednisolone, valporic- Acid and benzodiazepines. In view of rapid appearance of seizure resistance to these medications and drug side effects particularly ACTH and prednisolone, usage of above mentioned pharmacologic agent it not problem. In a randomized control, double blind trial study we tried in pediatric neurology department at Mofid childrenʹs hospital, during 1377-79(1998-2000) 60 children in the age group of 2-24 month who had I.S were admitted and treated with either Nitrazepam (NZP) or ACTH. In this experience, patients were divided randomly into two groups: group Nitrazepam (NZP) received NZP (0.5-1 mg /kg /24h) in three divided done taken with meals, in-group ACTH the patients took ACTH (40 U/ daily) intramuscular single dose. At the end of second and fourth and sixth week of treatment, the patients were evaluated for complete control or reductions of seizure and drug side effects. The result of this study revealed that at the end of six weeks of treatment 63 percent of NZP treated had complete seizure control while group ACTH. Children who received ACTH, stop of seizure occurred in 30 percent of them, which shows more patients with NZP enjoyed full recovery of devastating (I.S.) relative reduction of seizure frequency was observed in 26 percent group Nitrazepam (NZP) and 53 percent Group ACTH (P< 0.05). Reviewing patients EEG after six weeks of treatment showed complete normalization of tracing in NZP group 47 percent and in ACTH group 30 percent of them. Additionally this study vividly cleared the fact that NZP has less and negligible side effect compared to ACTH. Considering the better therapeutic effects, fewer side effects and lower cost of NZP in I.S patientʹs use of the drug choice is advised.