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Prognosis for seizure control in infantile spasms preceded by other seizures
1Service d'Explorations Fonctionnelles du Système Nerveux Central, INSERM U 29, Hôpital Saint Vincent de Paul, Paris, France.
Insights
Infantile spasms (IS) with prior seizures have varied steroid treatment responses. Steroids are effective for IS following acute brain damage but not for those stemming from prenatal encephalopathy.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Infantile spasms (IS) often present with other seizure types, indicating a poor prognosis.
- These co-occurring seizures can be a contraindication for steroid therapy.
Purpose of the Study:
- To investigate the impact of preceding seizure etiology on steroid treatment outcomes in infantile spasms.
- To identify rational indications for steroid administration in IS patients with prior seizures.
Main Methods:
- Retrospective analysis of 43 patients with infantile spasms treated with steroids.
- Categorization of patients based on the etiology of their first seizures preceding IS.
- Comparison of steroid treatment response based on seizure origin.
Main Results:
- Patients with IS preceded by prenatal encephalopathy (n=27) showed poor response to steroids.
- Patients with IS preceded by acute brain damage (n=16) exhibited favorable responses to steroid therapy.
- The etiology of initial seizures significantly correlated with epilepsy outcomes.
Conclusions:
- Steroid therapy for infantile spasms should consider the underlying cause of preceding seizures.
- Steroids are recommended for IS resulting from acute peri- or postnatal brain damage.
- IS with prenatal encephalopathy may require alternative treatment strategies.
Abstract:
Thirteen to 43% of patients with infantile spasms (IS) have other types of seizures, which are considered a feature of an unfavourable prognosis and, to some extent, as a contra-indication for steroid treatment. The present series comprised 43 patients treated with steroids, who suffered from other types of seizures prior to IS. The first seizures resulted from 2 different conditions, correlated to a different outcome of epilepsy. In 27 patients with prenatal encephalopathy, the first seizures were the first manifestation of the epilepsy and IS responded poorly to steroids. In the other 16 patients, the first seizures were occasional, due to acute brain damage, and the following IS responded favourably to steroid therapy. Rational therapeutic indications should take in account the etiology of seizures that precedes IS, and steroids should be administered when IS are due to acute peri- or postnatal acute brain damage.