POMC and Hypsarrhythmia: First-line treatment for IS consists of steroid or steroid-inducing treatment, but the choice of prednisolone/prednisone (PRED) or adrenocorticotropic hormone (ACTH) has conflicting or equivocal data on efficacy, including time to remission, resolution of hypsarrhythmia, and outcomes (2, 5).