Objectives: Use of adrenocorticotropin  hormone  (ACTH) is the treatment of choice in West syndrome. However, in infantile spasms caused by human cytomegalovirus (HCMV)  or herpesvirus type -1 (HSV1) ACTH therapy could be dangerous. The results of simultaneous treatment with ganciclovir  (GCV) and acyclovir (ACV) in West syndrome are presented.

Material and Methods: 26 infants ( 12 male, y  14 female) were simultaneously treated  with intramuscular steroid and  intravenous antiviral regimen.  Thereafter therapy  with oral antiviral drugs was continued. Cerebrospinal fluid examinations were performed for DNA HCMV and DNA HSV 1.  

Results: The most early onset of the combined therapy was 4 months.  6 infants have confirmed neuroinfection (5 with CMV and 1 HSV1). 15 were treated with antiviral drugs before simultaneous regimen. In 6 infants combined ACTH and  GCV therapy started without  previous antiviral treatment. The mean duration of the ACTH and GCV,ACV  intravenous regimen was 4 weeks. All infants received 2 or 3 antiepileptic drugs. In 10 patients (one after HSV 1 encephalitis) cessation of seizures was achieved. In 16 infants reduction of spasms  frequency was higher than 50%. There was no significant differences with other West syndrome cases treated with ACTH (p>0,05). Only one patient  required ketogenic diet and  treatment with vagus nerve stimulation. Despite  the active HCMV,HSV1 infection none of the patients had side effects of the ACTH and antiviral regimen.

Conclusion: Simultaneous ACTH and antiviral therapy can be used even in  early  drug-resistant  epilepsy caused by cytomegalovirus and herpersvirus type 1 neuroinfection.