Effects of ACTH Treatment in Infantile Spasm; Insights from Electrocardiography and Echocardiography

Objective: Infantile spasms (ISs) are a group of epileptic disorders, which represents the most frequent type of epilepsy in the first year of life. The most effective treatment for IS is adrenocorticotropic hormone (ACTH). We hypothesized that ACTH treatment might have cardiac adverse effects. This study aimed to evaluate the effects of ACTH treatment on the heart muscle and/or arrhythmia risk in patients with IS. Methods Twenty-four patients with IS and 24 healthy children (control group) participated in the study. Electroencephalography (EEG), electrocardiography (ECG), and transthoracic echocardiography were studied during treatment, and evaluations were made at 0-2-4 and 6th months of the treatment. Results None of the patients had significant tachycardia or bradycardia when compared with the healthy group, or during treatment. On the other hand, values of the PR, QRS, QT, tp/te, tpte/QT, and tpte/QTc values were significantly increased compared with either pretreatment values or each other, which indicated an increased arrhythmia risk in the patient group. In transthoracic echocardiographic examinations, we observed diminished diastolic dysfunctions, either with pulse wave or TDI Doppler. We found a significant difference between the groups in terms of longitudinal strain parameters. Conclusion Although we use low-dose and short-duration ACTH treatment in patients with IS, it may cause subclinical damage to the heart muscle and an increased risk of arrhythmia.