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[Cerebral computed tomography in infantile spasms]
H Pedersen1, K Neergaard, P Howitz
1Rigshospitalet, neuroradiologisk afsnit, København.
Insights
Computed tomography (CT) revealed abnormalities in 60% of infantile spasms cases. However, CT findings did not correlate with psychomotor development, suggesting early treatment is key for idiopathic infantile spasms.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Developmental Neuroscience
Background:
- Infantile spasms are a severe epilepsy syndrome in infants.
- Early diagnosis and treatment are crucial for optimal neurodevelopmental outcomes.
- The role of neuroimaging in classifying infantile spasms remains important.
Purpose of the Study:
- To investigate the utility of computed tomography (CT) in evaluating children with infantile spasms.
- To correlate CT findings with psychomotor development in infantile spasms.
- To differentiate between symptomatic and idiopathic infantile spasms using CT.
Main Methods:
- A prospective study involving 52 children diagnosed with infantile spasms.
- All participants underwent computed tomography (CT) brain imaging.
- Psychomotor development was assessed in relation to CT findings.
Main Results:
- Computed tomography (CT) showed normal findings in 40% of cases.
- Pathological CT findings included ventricular/subarachnoid space dilatation (17%), congenital malformations (19%), and cerebrovascular changes (19%).
- No significant difference in psychomotor development was observed between children with normal and abnormal CT scans.
Conclusions:
- Computed tomography (CT) is valuable for differentiating symptomatic from idiopathic infantile spasms.
- Early initiation of ACTH treatment may lead to a good prognosis in idiopathic cases, irrespective of CT findings.
- Subtle malformations like neuronal heterotopia may be missed by CT, with MRI potentially offering better visualization.
Abstract:
A prospective investigation of 52 children with infantile spasms was carried out employing computed tomography. Normal conditions were demonstrated in 21 (40%). Among the 31 children with pathological computed tomografic findings, dilatation of the ventricular system and/or subarachnoid space was found in nine cases (17%), congenital malformations in ten (19%) and cerebrovascular changes in a similar number (19%). One patient had a tumour and one had congenital toxoplasmosis. No significant differences were found in the frequencies of normal psychomotor development between children with normal and abnormal computed tomographic findings. The reason for this is probably that a good prognosis may be anticipated in the idiopathic forms provided that ACTH treatment is initiated early in the course of the disease. Computed tomography is useful to differentiate between symptomatic and idiopathic cases of infantile spasms. It may, however, be assumed that neuronal heterotopy without other malformations in the central nervous system may be difficult to diagnose with computed tomography. Magnetic resonance scanning will probably be able to demonstrate these cases.