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

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 (MgSO(4)+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 MgSO(4)+ACTH combination therapy after first‐line treatments failed. The course of treatments was 2 weeks. The therapeutic dose of ACTH and MgSO(4) 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 MgSO(4)+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, MgSO(4)+ACTH combination therapy can be considered.