Practice Experience in the Treatment of Infantile Spasms at a Tertiary Care Center

Abstract Background The current treatment guidelines for treatment of infantile spasms is ambiguous regarding individuals with known etiology and is backed by limited evidence. Recently published survey data reveal diverse treatment variation for infantile spasms. We conducted a retrospective medica...

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Bibliographic Details
Published in:Pediatric neurology 2014-11, Vol.51 (5), p.696-700
Main Authors: Thodeson, Drew, MD, Sogawa, Yoshimi, MD
Format: Article
Language:English
Subjects:
ACTH
Anticonvulsants - therapeutic use
Child, Preschool
Cohort Studies
Databases, Factual - statistics & numerical data
Electroencephalography
epilepsy
Female
Hormones - therapeutic use
Humans
Infant
infantile spasms
Male
Neurology
Pediatrics
Spasms, Infantile - diagnosis
Spasms, Infantile - etiology
Spasms, Infantile - therapy
treatment
Treatment Outcome
vigabatrin
Vigabatrin - therapeutic use
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Summary:Abstract Background The current treatment guidelines for treatment of infantile spasms is ambiguous regarding individuals with known etiology and is backed by limited evidence. Recently published survey data reveal diverse treatment variation for infantile spasms. We conducted a retrospective medical record review to better understand the clinical variables which affect treatment selection for new-onset infantile spasms. Methods We systematically extracted demographic data and treatment response of children with new onset infantile spasms over a 3-year period at a single institution. Treatment was divided into three groups: vigabatrin, hormone treatment, and other therapies. Results Our final cohort had 65 patients; 74% had a known etiology. Sixty-two percent were initially treated with vigabatrin. Other therapies were used more often in known etiology than in unknown etiology as initial treatment (40% versus 6%; P  = 0.002). Treatment response at 3 months was not statistically different between unknown etiology and known etiology groups (71% versus 46%; P  = 0.08). Overall, initial treatment choice was effective in 35% (23 of 65). Eighty-six percent (37 of 42) who failed the initial medication had subsequent medication trials within 3 months. Conclusions Etiology was strongly associated with initial treatment choice. The variation in treatment choice at our center reflects the limited evidence derived from well-designed clinical trials.
ISSN:0887-8994
1873-5150
DOI:10.1016/j.pediatrneurol.2014.07.019