Related Experiment Video
Updated: Aug 9, 2026
Enhancing the Development and Growth of Infant Cerebral Palsy Rats Using Selective Spinal Manipulations
Published on: February 2, 2024
Treatment of infantile spasms
E Hancock1, J P Osborne, P Milner
1c/o Room 2.28 Clinical Science Centre for Research & Education, Lower Lane, Liverpool, Merseyside, UK, L9 7LJ. ellie.tom@virgin.net
Insights
This review found no reliable evidence that any drug is more effective for infantile spasms (West's Syndrome). More research is needed to determine optimal treatments for this epilepsy syndrome.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Infantile spasms (West's Syndrome) are a severe epilepsy syndrome characterized by specific seizures, often with psychomotor retardation.
- The underlying causes and pathophysiology of infantile spasms remain poorly understood, complicating treatment strategies.
Purpose of the Study:
- To compare the efficacy of single-drug treatments for infantile spasms on long-term psychomotor development, subsequent epilepsy, spasm control, and side effects.
Main Methods:
- A systematic search of multiple databases (Cochrane Epilepsy Group, MEDLINE, EMBASE) and other sources was conducted.
- Included were randomized controlled trials (RCTs) evaluating drug administration in infantile spasms.
- Data extraction and quality assessment were performed by three independent reviewers, focusing on spasm cessation, psychomotor development, and adverse events.
Main Results:
- Ten small RCTs with 335 participants tested eight drugs; overall study quality was poor.
- No studies assessed long-term psychomotor development or other seizure types.
- Limited evidence suggested vigabatrin may be more effective than hydrocortisone for spasms in tuberous sclerosis, and ACTH more effective than prednisone.
Conclusions:
- There is a lack of reliable evidence to support the superiority of any specific drug for infantile spasms.
- Few trials adequately assessed psychomotor development or long-term seizure outcomes.
- Larger, longer-term trials are essential to establish effective and safe treatments for infantile spasms.
Background:
Infantile spasms (West's Syndrome) is a syndrome which includes a peculiar type of epileptic seizure, usually hypsarrhythmia and in the majority of patients, psychomotor retardation. It remains poorly understood and despite modern imaging techniques an underlying cause is often not found. Little is known about their pathophysiological basis and treatment remains problematic.
Objectives:
To compare the effects of single drugs used to treat infantile spasms upon long-term psychomotor development, subsequent epilepsy, control of the spasms and side effects.
Search Strategy:
Our search included the Cochrane Epilepsy Group trials register, MEDLINE (1960 to 2001), EMBASE (1981 to 2001), contacting pharmaceutical companies and appeals at international conferences.
Selection Criteria:
Randomized controlled trials (RCTs) of the administration of drugs to people with infantile spasms.
Data Collection And Analysis:
Three reviewers independently selected trials for inclusion and extracted data. Study quality and potential sources of heterogeneity were assessed. Outcomes included cessation of spasms, time to cessation of spasms, participants with cessation of spasms remaining spasm free, reduction in spasms, resolution of hypsarrhythmia, subsequent epilepsy rates and side effects.
Main Results:
Ten small RCTs were included. In total these studies recruited just 335 participants and tested eight different drugs. Overall, studies were of poor methodological quality. No study assessed long-term psychomotor development or the development of other seizure types. One small study found vigabatrin to be more efficacious than hydrocortisone in stopping infantile spasms in a group of people with tuberous sclerosis. One underpowered study showed a trend for vigabatrin to be more efficacious than placebo in stopping infantile spasms, two small studies when combined showed ACTH to be more efficacious than low-dose prednisone (2mg/kg). It was not possible to compare reduction in the number of spasms between the different treatments because of differences in methods of analysis. Overall, only nine participants were reported to have been withdrawn from the trial treatments due to side effects and two deaths were reported.
Reviewer'S Conclusions:
We found no reliable evidence that any of the treatments assessed were more efficacious than any other. Few studies considered psychomotor development or subsequent seizure rates as outcomes and none had long term follow-up. Further trials with larger numbers of participants, and longer follow-up are required.
More Related Videos
Related Concept Videos
01:28Classification of Skeletal Muscle Relaxants
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
01:26Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin
The binding of dantrolene to the RYR1...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
01:09Peripherally and Centrally Acting Muscle Relaxants: A Comparison
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic drugs,...
01:24Centrally Acting Muscle Relaxants: Therapeutic Uses
Centrally acting drugs are classified into spasmolytic and antispasmodic drugs. Spasmolytic drugs such as baclofen, diazepam, and tizanidine inhibit spinal motor neurons and decrease muscle tone. Spasmolytic drugs are administered for severe and chronic spasms due to multiple sclerosis, cerebral palsy, stroke, and spinal cord and muscle injuries. However,...
01:29Tetanus