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Cranial computed tomography in infantile spasms. Primary findings related to long-term mental prognosis
P Howitz1, K Neergaard, H Pedersen
1Department of Paediatrics, University Hospital, Rigshospitalet, Copenhagen, Denmark.
Insights
Cranial CT scans in infantile spasms (IS) revealed abnormalities in 60% of cases. Abnormal CT findings, excluding atrophy, correlated with poor long-term mental outcomes in children with IS.
Area of Science:
- Pediatric Neurology
- Neuroradiology
Background:
- Infantile spasms (IS) are a severe epilepsy syndrome in infants.
- Clinical classification of IS includes cryptogenic (CR), symptomatic (SY), and doubtful (DO) categories.
- Cranial computed tomography (CT) is a neuroimaging technique used to evaluate brain structure.
Purpose of the Study:
- To evaluate the utility of cranial CT scans in children with infantile spasms.
- To determine the correlation between CT findings and clinical classification of IS.
- To assess the prognostic value of CT findings for long-term mental development.
Main Methods:
- Prospective study of 109 children with IS (1976-1979).
- 52 children underwent cranial computed tomography (CT) examination.
- IS classification (CR, SY, DO) was based on clinical presentation prior to CT analysis.
Main Results:
- Abnormal CT findings were observed in 60% of the examined children.
- Cerebral atrophy was found in only 20% of children treated with ACTH, suggesting it's not an obligatory side-effect.
- Normal CT findings in 50% of CR and 50% of SY+DO groups did not predict mental development.
- Abnormal CT findings (excluding atrophy) strongly correlated with clinical symptoms and indicated a poor long-term mental prognosis.
Conclusions:
- Cranial CT scanning is a valuable diagnostic tool for evaluating children with infantile spasms.
- Abnormal CT findings, particularly those not related to atrophy, are associated with unfavorable long-term mental outcomes.
- CT findings, in conjunction with clinical assessment, aid in predicting prognosis for mental development in IS patients.
Abstract:
Out of 109 children with infantile spasms (IS), prospectively tested during the years 1976 to 1979 in Denmark, 52 children were examined by cranial computed tomography (CT). The classification of IS into cryptogenic (CR), symptomatic (SY) and doubtful (DO) was done clinically without considering the CT-findings. Sixty per cent of the scannings were abnormal. Only 6/30 (20%) of the children in ACTH treatment were found to develop cerebral atrophy which means that this finding is not an obligatory side-effect of ACTH treatment of children with IS. Normal CT-findings were found in 50% of the CR and 50% of the SY + DO-groups, and could not be used as a prognostic tool for estimating the mental development. This was also the case for children with cerebral atrophy. Abnormal CT-findings (minus atrophy) were highly correlated to the group with clinical symptoms and indicate an extremely unsatisfying long-term mental prognosis. CT-scanning is a valuable tool for the examination of clearing children with infantile spasms.