Treatment of children with infantile spasms: A network meta-analysis

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#adrenocorticotropic-hormone #anticonvulsants #child #humans #infant

Treatment of children with infantile spasms: A network meta-analysis

Jain et al., 2022 | Dev Med Child Neurol | Systematic Review

Citation

Jain Puneet, Sahu Jitendra K, ... Arya Ravindra. Treatment of children with infantile spasms: A network meta-analysis. Dev Med Child Neurol. 2022-Nov;64(11):1330-1343. doi:10.1111/dmcn.15330

Abstract

AIM: We performed a systematic review and network meta-analysis (NMA) to obtain comparative effectiveness estimates and rankings of non-surgical interventions used to treat infantile spasms. METHOD: All randomized controlled trials (RCTs) including children 2 months to 3 years of age with infantile spasms (with hypsarrhythmia or hypsarrhythmia variants on electroencephalography) receiving appropriate first-line medical treatment were included. Electroclinical and clinical remissions within 1 month of starting treatment were analyzed. RESULTS: Twenty-two RCTs comparing first-line treatments for infantile spasms were reviewed; of these, 17 were included in the NMA. Both frequentist and Bayesian network rankings for electroclinical remission showed that high dose adrenocorticotropic hormone (ACTH), methylprednisolone, low dose ACTH and magnesium sulfate (MgSO4 ) combination, low dose ACTH, and high dose prednisolone were most likely to be the 'best' interventions, although these were not significantly different from each other. For clinical remission, low dose ACTH/MgSO4 combination, high dose ACTH (with/without vitamin B6 ), high dose prednisolone, and low dose ACTH were 'best'. INTERPRETATION: Treatments including ACTH and high dose prednisolone are more effective in achieving electroclinical and clinical remissions for infantile spasms. WHAT THIS PAPER ADDS: Adrenocorticotropic hormone and high dose prednisolone are more effective than other medications for infantile spasms. Symptomatic etiology decreases the likelihood of remission even after adjusting for treatment lag.

Key Findings

Twenty-two RCTs comparing first-line treatments for infantile spasms were reviewed; of these, 17 were included in the NMA. Both frequentist and Bayesian network rankings for electroclinical remission showed that high dose adrenocorticotropic hormone (ACTH), methylprednisolone, low dose ACTH and magnesium sulfate (MgSO4 ) combination, low dose ACTH, and high dose prednisolone were most likely to be the 'best' interventions, although these were not significantly different from each other. For clin

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Adrenocorticotropic Hormone
  • Anticonvulsants
  • Child
  • Humans
  • Infant
  • Magnesium Sulfate
  • Methylprednisolone
  • Spasms, Infantile
  • Treatment Outcome
  • Vitamins

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Network Meta-Analysis
  • Vertical: vitamin-b6

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09