Article Sidebar
Main Article Content
Abstract
First line treatments for infantile spasms has varied impact on outcomes especially in developing countries with resource limited settings. We sought to identify the impact of first line treatment on cessation of spasms, long-term epilepsy and developmental outcomes along with influence of etiology and lead time to treatment in a tertiary care hospital in south India. Electronic case records of infants between 3 months and 1 year of age diagnosed with infantile spasm who received first-line treatment including combination therapy between 2014 and 2018 were retrospectively reviewed for clinical details, electroencephalogram (EEG), etiology, treatment modality and their adverse effects, Infantile spasm cessation, developmental and long-term epilepsy outcomes.
The study included forty-four cases (32 boy, 12 girls), with mean age of onset at 7.6 weeks ± 3.5 weeks, median delay in diagnosis at 2 weeks (range of 1 day- 24 weeks), median lead time to treatment at 3.5 weeks (range 1 day- 28 weeks). First- line management was associated with cessation of spams in majority (67%) with no statistically significant difference in outcome based on choice of first-line agents. However, need for more than one first-line agents was associated with relatively more unfavorable long-term outcome. Structural etiology of Infantile Spasm was associated (p=0.001) with long- term epilepsy. Early treatment of Infantile spasms (<2 weeks) was associated with better (p=0.014) developmental outcome. In conclusion, clear guidelines are needed in developing countries including identification of etiology and early treatment of infantile spasms with first-line agents to improve developmental outcomes.
Keywords
Article Details
Copyright (c) 2025 Deepthi Gopinathan Nair, Dr Bidisha Banerjee, Dr L.Gowthami , Dr. Chitra Sankar
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
References
-
1. Chang YH, Chen C, Chen SH, Shen YC, Kuo YT. Effectiveness of corticosteroids versus adrenocorticotropic hormone for infantile spasms: a systematic review and meta-analysis. Ann Clin Transl Neurol. 2019;6(11):2270–2281.
2. James W Wheless, Patricia A Gibson, Kari Luther Rosbeck et al. Infantile spasms (West syndrome): update and resources for pediatricians and providers to share with parents. BMC Pediatr. 2012; 12: 108. Published online 2012 Jul 25.
3. GeorgesKarvelas, AnneLortiea, Morris H.Scantlebury, Paul T.Duya et al. A retrospective study on aetiology based outcome of infantile spasms. Elsevier , Volume 18, Issue 3, April 2009, Pages 197-201.
4. R.Ben Abdelaziz, A. Ben Chehida, M.LamouchiaS et al. Factors predictive of prognosis of infantile spasms. A retrospective study in a low-income country. Archives de Pédiatrie
Volume 26, Issue 1, January 2019, Pages 1.
5. Pellock, J.M., Hrachovy, R., Shinnar, S. et al, Infantile spasms: a U.S. consensus report. Epilepsia. 2010;51:2175–2189.
6. Fenichels clinical pediatric neurology, seventh edition, parozysmal disorders, P-19
7. Hussain, S.A. Treatment of infantile spasms. Epilepsia Open. 2018;3:143–154
8. Gonzalez-Giraldo. Treating Infantile Spasms with High-Dose Oral Corticosteroids: A Retrospective Review of 87 Children. Ernesto et al. Pediatric Neurology, Volume 87, 30 - 35
9. Andrew L Lux, BMBS, Stuart W Edwards, PhD, Eleanor Hancock, MD et al. The United Kingdom Infantile Spasms Study (UKISS) comparing hormone treatment with vigabatrin on developmental and epilepsy outcomes to age 14 months: a multicentre randomised trial. The Lancet, Volume 4, ISSUE 11, P712-717, November 01, 2005
10. Chellamuthu P, Sharma S, Jain P, Kaushik JS, Seth A, Aneja S. High dose (4 mg/kg/day) versus usual dose (2 mg/kg/day) oral prednisolone for treatment of infantile spasms: an open label, randomized controlled trial. Epilepsy Res. 2014 Oct;108(8):1378-84.
11. O'Callaghan FJ, Edwards SW, Alber FD, Hancock E, Johnson AL, Kennedy CR, et al. Safety and effectiveness of hormonal treatment versus hormonal treatment with vigabatrin for infantile spasms (ICISS): a randomised, multicentre, open-label trial. Lancet Neurol. 2017 Jan;16(1):33
12. 42. Finbar J K O'Callaghan, PhD, Stuart W Edwards, PhD, Fabienne Dietrich Alber, MSc et al. Vigabatrin with hormonal treatment versus hormonal treatment alone (ICISS) for infantile spasms: 18-month outcomes of an open-label, randomised controlled trial. The Lancet, Articles| Volume 2, ISSUE 10, P715-725, October 01, 2018.
13. Widjaja E, Go C, McCoy B, Snead OC. Neurodevelopmental outcome of infantile spasms: A systematic review and meta-analysis. Epilepsy Res. 2015 Jan;109:155-62.
14. Nasiri J, Kachuei M, Kermani R, Samaninobandegani Z. Neurodevelopmental outcomes of the West syndrome in pediatric patients: The first report from the Middle-East.Res Dev Disabil. 2019 Jun;89:114-119.
15. Gonzalez-Giraldo E1, Stafstrom CE1, Stanfield AC2, Kossoff EH3. Treating Infantile Spasms with High-Dose Oral Corticosteroids: A Retrospective Review of 87 Children. Pediatr Neurol. 2018 Oct;87:30-35.
16. Knupp KG, Coryell J, Nickels KC et al. Response to treatment in a prospective national infantile spasms cohort.Ann Neurol. 2016 Mar;79(3):475-84.
17. Gulati S, Jain P, Kannan L et al.The Clinical Characteristics and Treatment Response in Children with West Syndrome in a Developing Country: A Retrospective Case Record Analysis. J Child Neurol. 2015 Oct;30(11):1440-7.
18. Kaushik JS1, Patra B, Sharma S et al. Clinical spectrum and treatment outcome of West Syndrome in children from Northern India.Seizure. 2013 Oct;22(8):617-21.
19. Vaddi VK1, Sahu JK2, Dhawan SR1 et al.Knowledge, Attitude and Practice (KAP) Study of Pediatricians on Infantile Spasms.Indian J Pediatr. 2018 Oct;85(10):836-840.
References
2. James W Wheless, Patricia A Gibson, Kari Luther Rosbeck et al. Infantile spasms (West syndrome): update and resources for pediatricians and providers to share with parents. BMC Pediatr. 2012; 12: 108. Published online 2012 Jul 25.
3. GeorgesKarvelas, AnneLortiea, Morris H.Scantlebury, Paul T.Duya et al. A retrospective study on aetiology based outcome of infantile spasms. Elsevier , Volume 18, Issue 3, April 2009, Pages 197-201.
4. R.Ben Abdelaziz, A. Ben Chehida, M.LamouchiaS et al. Factors predictive of prognosis of infantile spasms. A retrospective study in a low-income country. Archives de Pédiatrie
Volume 26, Issue 1, January 2019, Pages 1.
5. Pellock, J.M., Hrachovy, R., Shinnar, S. et al, Infantile spasms: a U.S. consensus report. Epilepsia. 2010;51:2175–2189.
6. Fenichels clinical pediatric neurology, seventh edition, parozysmal disorders, P-19
7. Hussain, S.A. Treatment of infantile spasms. Epilepsia Open. 2018;3:143–154
8. Gonzalez-Giraldo. Treating Infantile Spasms with High-Dose Oral Corticosteroids: A Retrospective Review of 87 Children. Ernesto et al. Pediatric Neurology, Volume 87, 30 - 35
9. Andrew L Lux, BMBS, Stuart W Edwards, PhD, Eleanor Hancock, MD et al. The United Kingdom Infantile Spasms Study (UKISS) comparing hormone treatment with vigabatrin on developmental and epilepsy outcomes to age 14 months: a multicentre randomised trial. The Lancet, Volume 4, ISSUE 11, P712-717, November 01, 2005
10. Chellamuthu P, Sharma S, Jain P, Kaushik JS, Seth A, Aneja S. High dose (4 mg/kg/day) versus usual dose (2 mg/kg/day) oral prednisolone for treatment of infantile spasms: an open label, randomized controlled trial. Epilepsy Res. 2014 Oct;108(8):1378-84.
11. O'Callaghan FJ, Edwards SW, Alber FD, Hancock E, Johnson AL, Kennedy CR, et al. Safety and effectiveness of hormonal treatment versus hormonal treatment with vigabatrin for infantile spasms (ICISS): a randomised, multicentre, open-label trial. Lancet Neurol. 2017 Jan;16(1):33
12. 42. Finbar J K O'Callaghan, PhD, Stuart W Edwards, PhD, Fabienne Dietrich Alber, MSc et al. Vigabatrin with hormonal treatment versus hormonal treatment alone (ICISS) for infantile spasms: 18-month outcomes of an open-label, randomised controlled trial. The Lancet, Articles| Volume 2, ISSUE 10, P715-725, October 01, 2018.
13. Widjaja E, Go C, McCoy B, Snead OC. Neurodevelopmental outcome of infantile spasms: A systematic review and meta-analysis. Epilepsy Res. 2015 Jan;109:155-62.
14. Nasiri J, Kachuei M, Kermani R, Samaninobandegani Z. Neurodevelopmental outcomes of the West syndrome in pediatric patients: The first report from the Middle-East.Res Dev Disabil. 2019 Jun;89:114-119.
15. Gonzalez-Giraldo E1, Stafstrom CE1, Stanfield AC2, Kossoff EH3. Treating Infantile Spasms with High-Dose Oral Corticosteroids: A Retrospective Review of 87 Children. Pediatr Neurol. 2018 Oct;87:30-35.
16. Knupp KG, Coryell J, Nickels KC et al. Response to treatment in a prospective national infantile spasms cohort.Ann Neurol. 2016 Mar;79(3):475-84.
17. Gulati S, Jain P, Kannan L et al.The Clinical Characteristics and Treatment Response in Children with West Syndrome in a Developing Country: A Retrospective Case Record Analysis. J Child Neurol. 2015 Oct;30(11):1440-7.
18. Kaushik JS1, Patra B, Sharma S et al. Clinical spectrum and treatment outcome of West Syndrome in children from Northern India.Seizure. 2013 Oct;22(8):617-21.
19. Vaddi VK1, Sahu JK2, Dhawan SR1 et al.Knowledge, Attitude and Practice (KAP) Study of Pediatricians on Infantile Spasms.Indian J Pediatr. 2018 Oct;85(10):836-840.