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For approximately fifty years hormonal therapy with ACTH or prednisone has been the staple of treatment for infantile spasms. However, studies detailing the therapeutic properties of these compounds have been fraught with uncertainty. Many controversies still exist concerning the relative efficacy, optimal dose and timing, and predictive factors for good responsiveness to ACTH and corticosteroids. No placebo-controlled trials of ACTH or steroids have been performed. In most open-label or retrospective studies, ACTH or prednisone induces a reduction or complete cessation of spasms, as well as an improvement in the EEG, in approximately 50-75% of patients. This effect is usually realized within a couple weeks. While some studies report similar efficacy of ACTH and prednisone, others indicate that ACTH is more effective. Some patients who do not initially respond to ACTH may respond to prednisone and vice-versa. A large variety of doses of ACTH have been used, but there is no evidence that larger doses (150 units / meter2/day) are more effective than lower doses (20-30 units/day).
Most of the newer anticonvulsants are useful for add on drugs for generalized and partial seizures in children. The congnitive and behavioural problems are much less with these drugs.
Ref: http://www.neuro.wustl.edu/
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