Objective      To analyze the efficacy of adrenocorticotropic hormone (ACTH) as the first-line and non-first-line drug in treatment of infantile spasms.       Methods      The medical records of 50 patients with infantile spasms (19 patients taking ACTH as the first-line drug and 31 patients taking ACTH as the non-first-line drug) in the inpatient department of Shenzhen Children’s Hospital from 1999 to 2010 were retrospectively analyzed. We compared the recent (within 8 weeks) spasm-free rate and the influence of the order of ACTH choice as the antiepileptic drug on the spasm-free rate of the patients.       Results      Fourteen patients were recently spasm-free in the 19 patients taking ACTH as the first-line drug (74%)

and 14 patients were recently spasm-free in the 31 patients taking ACTH as the non-first-line drug (45%). The difference of the efficacy between the two groups was statistically significant (Chi-square=3.889

P0.05). Among the 31 patients

15 patients were treated with ACTH after the failure of one antiepileptic drug

and 8 patients were spasm-free (53%); 10 patients were treated with ACTH after the failure of combining two antiepileptic drugs

and 4 patients were spasm-free (36%); 5 patients were treated with ACTH after the failure of combining three antiepileptic drugs

and 1 patient (20%) was spasm-free; and 1 patient was treated with ACTH after the failure of combining five antiepileptic drugs

and were spasm-free.       Conclusion      The patients with infantile spasms who are treated with ACTH as first line drug can get a high spasm-free rate (74%). The patients who are treated with ACTH after the failure of other antiepileptic drugs have smaller chance to become spasm-free (53%). But ACTH therapy is still worth trying even if three antiepileptic drugs have failed.