{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:07:58Z","timestamp":1781230078683,"version":"3.54.1"},"reference-count":59,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T00:00:00Z","timestamp":1656460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>We performed a systematic review and network meta\u2010analysis (NMA) to obtain comparative effectiveness estimates and rankings of non\u2010surgical interventions used to treat infantile spasms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>All randomized controlled trials (RCTs) including children 2\u2009months to 3\u2009years of age with infantile spasms (with hypsarrhythmia or hypsarrhythmia variants on electroencephalography) receiving appropriate first\u2010line medical treatment were included. Electroclinical and clinical remissions within 1\u2009month of starting treatment were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010two RCTs comparing first\u2010line 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 (MgSO<jats:sub>4<\/jats:sub>) combination, low\u00a0dose ACTH, and high\u00a0dose prednisolone were most likely to be the \u2018best\u2019 interventions, although these were not significantly different from each other. For clinical remission, low dose ACTH\/MgSO<jats:sub>4<\/jats:sub> combination, high\u00a0dose ACTH (with\/without vitamin B<jats:sub>6<\/jats:sub>), high\u00a0dose prednisolone, and low\u00a0dose ACTH were \u2018best\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Treatments including ACTH and high\u00a0dose prednisolone are more effective in achieving electroclinical and clinical remissions for infantile spasms.<\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Adrenocorticotropic hormone and high\u00a0dose prednisolone are more effective than other medications for infantile spasms.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Symptomatic etiology decreases the likelihood of remission even after adjusting for treatment 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