这是一个潜在的,随机化,双盲,单中心安慰剂对照试验,以评估褪黑素作为婴儿癫痫性痉挛综合征(IESS)的附加治疗的有效性和安全性。招募年龄在3个月至2岁之间,主要诊断为IESS的参与者,并以1:1的比例分为两组。两组均接受促肾上腺皮质激素(ACTH)和硫酸镁(MgSO4)联合治疗2周,治疗组还在每天20:00至21:00之间接受褪黑激素(3毫克),睡前0.5-1小时。该研究的主要终点是通过癫痫发作日记评估的痉挛频率的平均减少率。次要终点包括对反应率的评估,脑电图心律失常(克莱默评分),和精神运动发育(丹佛发育筛查测试,DDST)。使用简短的婴儿睡眠问卷(BISQ)评估睡眠质量,婴儿睡眠评估量表(ISAS),和活动记录。还评估了安全性参数。对意向治疗和符合方案的人群进行了统计分析。该试验在Clinicaltrials.gov(ChiCTR2000036208)注册。在119名接受筛查的患者中,70例随机分组,66例完成治疗。在意向治疗人群中,痉挛频率平均减少百分比没有显著差异(中位数[四分位距,IQR:Q3-Q1],100%[46.7%]vs.66.7%[55.3%],p=.288),3天反应率(51.4%vs.37.1%,p=.229),28天反应率(42.9%vs.28.6%,p=.212),EEGKramer评分(2[3.5]vs.2[3],p=.853),或DDST综合月(5[2.5]vs.6[6],p=.239)在褪黑激素(n=35)和安慰剂(n=35)组之间。然而,护理人员报告说,褪黑激素治疗后睡眠质量有所改善,85.7%的人报告有规律的睡眠,而安慰剂组则为42.9%(42.9%,p<.001)。与安慰剂相比,褪黑素组在4-11个月大的患者中的ISAS评分较低(平均值±SD,29.3±4.4vs.35.2±5.9,p<.001)。此外,褪黑激素治疗后,睡眠发作潜伏期的中位数(IQR)值缩短了6.0(24.5)分钟,而安慰剂组延长了3.0(22.0)min(p=.030)。褪黑素组患儿治疗后血清褪黑素(6:00h)水平(pg/mL)明显高于安慰剂组(中位数[IQR],84.8[142]vs.17.5[37.6],p<.001)。研究中未观察到与褪黑激素相关的不良反应,褪黑素组和安慰剂组之间的不良反应没有显着差异。虽然没有统计学意义,这项随机临床试验的结果证明,作为一种附加治疗,在IESS治疗中可以提高痉挛控制率。对于接受ACTH治疗的IESS儿童,褪黑激素的加入被发现可以改善睡眠质量,缩短睡眠发作潜伏期,并增加血液褪黑激素水平。此外,它被认为是一种安全的治疗选择.
This was a prospective, randomized, double-blind, single-center placebo-controlled trial to assess the efficacy and safety of melatonin as an add-on treatment for infantile epileptic spasms syndrome (IESS). Participants aged 3 months to 2 years with a primary diagnosis of IESS were recruited and assigned to two groups in a 1:1 ratio. Both treatment groups received a combination of adrenocorticotrophic hormone (
ACTH) and magnesium sulfate (MgSO4 ) for 2 weeks, and the treatment group also received melatonin (3 mg) between 20:00 and 21:00 daily, 0.5-1 h before bedtime. The
study\'s primary endpoint was the average reduction rate in spasm frequency assessed by seizure diaries. Secondary endpoints included assessment of the response rate, EEG hypsarrhythmia (Kramer score), and psychomotor development (Denver Developmental Screening Test, DDST). Sleep quality was assessed by using the Brief Infant Sleep Questionnaire (BISQ), the Infant Sleep Assessment Scale (ISAS), and actigraphy. Safety parameters were also evaluated. Statistical analyses were conducted on intention-to-treat and per-protocol populations. The
trial is registered at Clinicaltrials.gov (ChiCTR2000036208). Out of 119 screened patients, 70 were randomized and 66 completed treatments. In the intention-to-treat population, there were no significant differences in the average percentage reduction of spasm frequency (median [interquartile range, IQR: Q3-Q1], 100% [46.7%] vs. 66.7% [55.3%], p = .288), the 3-day response rate (51.4% vs. 37.1%, p = .229), the 28-day response rate (42.9% vs. 28.6%, p = .212), EEG Kramer scores (2 [3.5] vs. 2 [3], p = .853), or DDST comprehensive months (5 [2.5] vs. 6 [6], p = .239) between the melatonin (n = 35) and placebo (n = 35) groups. However, caregivers reported improved sleep quality after melatonin treatment, with 85.7% reporting regular sleep compared to 42.9% with placebo (42.9%, p < .001). The melatonin group had lower ISAS scores in 4-11-month-old patients compared to the placebo (mean ± SD, 29.3 ± 4.4 vs. 35.2 ± 5.9, p < .001). Moreover, the median (IQR) value of sleep-onset latency was shortened by 6.0 (24.5) min after melatonin treatment, while that in the placebo group was extended by 3.0 (22.0) min (p = .030). The serum melatonin (6:00 h) level (pg/mL) of the children in the melatonin group after treatment was significantly higher than in the placebo group (median [IQR], 84.8 [142] vs. 17.5 [37.6], p < .001). No adverse effects related to melatonin were observed in the
study, and there were no significant differences in adverse effects between the melatonin and placebo groups. Although not statistically significant, the results of this randomized clinical trial proved that melatonin supplementation, as an add-on treatment, can improve spasm control rate in the treatment of IESS. For IESS children treated with
ACTH, the addition of melatonin was found to improve sleep quality, shorten sleep onset latency, and increase blood melatonin levels. Moreover, it was observed to be a safe treatment option.