POMC and infantile spasms: In a chart review,4838 children with IESS received VGB (12.5 to 25 mg/kg/day, maximum dose 150 mg/kg/day) and 18 received ACTH (40 IU; 2 children received 80 IU); 50% of the patients achieved complete cessation with ACTH in monotherapy versus 55.3% with VGB.48For the nonresponders, treatments were switched, and 29.4% presented complete cessation with ACTH and 22.2% with VGB.48A total of 55.6% of the patients initially treated with ACTH relapsed, compared with 33.3% with VGB.48