Three studies excluded patients with a history of tuberous sclerosis and four excluded those who had already received other treatments.19, 27, 28, 29 Variable lead time to treatment, the time between the onset of spasms and the commencement of treatment were noted in Hrachovy’s study.30 Hrachovy et al. and Baram et al. used the porcine ACTH in their studies.29, 30 Lux et al., Wanigasinghe et al., and Gowda et al. administered synthetic ACTH.19, 27, 28 The characteristics of all five studies and administration details of each therapy are listed in Table 1. This evidence concerns the gene POMC and tuberous sclerosis.