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Two Cases of Infantile Spasms Complicated by Urolithiasis Developed for a Short Period of Time during ACTH-Zonisamide Therapy

Masahiro Shiraish, Shinobu Fukumura, Toshihide Watanabe and Kimio Minagawa

A 19-month-old female and a 16-month-old male child with intractable seizures were diagnosed as infantile
spasms on the basis of their symptoms, clinical courses and EEGs. Both of them were born at 23 weeks gestation.
We treated them by combination therapy with adrenocorticotrophic hormone (ACTH) and zonisamide (ZNS).
However, urolithiasis was confirmed by computed tomography at 10 days and 12 days, respectively, after starting
the combination therapy. We need to recognize that combination therapy with ACTH and ZNS carries a high risk
of development of urolithiasis, and this adverse effect can happen at an early date. Regular urinalysis should
be performed during therapy with these drugs, and if the presence of urolithiasis is suspected, CT scan or renal
ultrasonography should be performed.