A study published in Neurology offered Class III evidence that for children with newly onset infantile spasms, adrenocorticotropic hormone (ACTH) or oral steroids have superior efficacy when compared to non-standard therapies. Researchers aimed to investigate the efficacy of initial therapy for infantile spasms that initiated at age 2-24 months in children.

Children with novel onset infantile spasms were prospectively followed by the National Infantile Spasms Consortium. Freedom from therapy failure at sixty days needed no 2^nd  therapy for infantile spasms and no clinical spasms following thirty days of therapy initiation. With the aid of within-center correlation with generalized estimating equations and propensity score weighting, management of therapeutic selection bias was done. The freedom from treatment failure rates is shown in Table 1:

The alteration from oral steroids to ACTH was not estimated to impact response (noted 44% estimated to alter to 44%). The alteration from the non-standard treatment to ACTH would enhance response from 8% to 39%, and to oral steroids from 8% to 38%. Notably, large but not profound estimated effects of altering from vigabatrin to ACTH (29% to 42%), vigabatrin to oral steroids (29% to 42%), and non-standard treatment to vigabatrin (8% to 20%) were witnessed.

Considering children managed with vigabatrin, children suffering from tuberous sclerosis complex responded more frequently when compared to others (62% vs 29%). The estimated efficacy of vigabatrin is between non-standard treatment and ACTH / oral steroids, despite the fact that the study sample was underpowered for statistical confidence. When utilized, vigabatrin worked best for the tuberous sclerosis complex.