[Treatment of infantile spasms]

Area of Science:

• Pediatric Neurology
• Epileptology
• Developmental Neuroscience

Context:

• Infantile spasms (IS) present with developmental regression, characteristic seizures, and hypsarrhythmia.
• Current medical treatments for IS include adrenocorticotropic hormone, prednisolone, and vigabatrin.
• Tuberous sclerosis-associated IS demonstrates particular responsiveness to vigabatrin.

Purpose:

• To evaluate the efficacy of medical treatments for infantile spasms (IS).
• To assess the impact of IS treatment on both short-term and long-term outcomes.
• To review current recommendations for IS pharmacotherapy.

Summary:

• Medical treatment of IS is associated with positive short-term outcomes, including spasm resolution and hypsarrhythmia normalization.
• Data are currently insufficient to establish the effectiveness of medical treatment in improving long-term outcomes for infantile spasms.
• Adrenocorticotropic hormone and prednisolone are recommended but frequently cause side effects; vigabatrin is also advised, especially for IS linked to tuberous sclerosis.

Impact:

• Highlights the need for further research into long-term outcome predictors and treatments for infantile spasms.
• Informs clinical practice regarding the limitations of current therapies for achieving sustained developmental benefits.
• Emphasizes the importance of considering etiology, such as tuberous sclerosis, when selecting IS treatment.