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Infantile spasms: A prognostic evaluation
Mary Iype1, Geetha Saradakutty2, Puthuvathra Abdul Mohammed Kunju1
1Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India.
Insights
Infantile spasms prognosis is concerning, with only 51% seizure freedom and significant developmental delays. Early identification of seizure predictors is crucial for better outcomes in infants with spasms.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
Background:
- Comprehensive prognostic data for infantile spasms, focusing on seizure profiles and psychomotor outcomes, remains limited.
- Infantile spasms (IS) represent a significant neurological challenge in early childhood, necessitating detailed prognostic evaluation.
Purpose of the Study:
- To comprehensively evaluate the etiology, demographics, semiology, EEG, and radiological patterns in infantile spasms.
- To assess seizure control, psychomotor development, and EEG resolution following treatment for IS.
- To identify factors influencing spasm control, EEG normalization, and psychomotor development at a 3-year follow-up.
Main Methods:
- Recruitment of 50 newly diagnosed infantile spasms cases (age 1-12 months) with hypsarrhythmia on EEG.
- Follow-up of 43 patients for a duration of 3 years to assess outcomes.
- Utilized multivariate analysis to identify predictors for seizure control and psychomotor development.
Main Results:
- At 3-year follow-up, 51% of children achieved seizure freedom, and 37% had normalized EEGs.
- A high prevalence of autistic features (74%) was observed; only 11.6% of all children exhibited normal development across all assessed domains.
- Predictors for poor seizure outcome included the presence of additional seizure types and lack of response to 28-day adrenocorticotropic hormone (ACTH) treatment.
Conclusions:
- Two key factors were identified that predict seizure freedom in infantile spasms.
- While seizure control rates are comparable to existing literature, the long-term cognitive outcomes for children with infantile spasms remain discouraging.
- Further research is needed to improve developmental trajectories and long-term prognoses for affected children.
Background:
Few papers address the comprehensive prognosis in infantile spasms and look into the seizure profile and psychomotor outcome.
Objective:
We aimed to follow up children with infantile spasms to study: a) the etiology, demographics, semiology, electroencephalogram (EEG), and radiological pattern; b) seizure control, psychomotor development, and EEG resolution with treatment; c) the effects of various factors on the control of spasms, resolution of EEG changes, and psychomotor development at 3-year follow-up.
Materials And Methods:
Fifty newly diagnosed cases with a 1-12 month age of onset and who had hypsarrhythmia in their EEG were recruited and 43 were followed up for 3 years.
Results:
Of the children followed up, 51% were seizure-free and 37% had a normal EEG at the 3-year follow-up. Autistic features were seen in 74% of the children. Only 22.7% among the seizure-free (11.6% of the total) children had normal vision and hearing, speech with narration, writing skills, gross and fine motor development, and no autism or hyperactivity. On multivariate analysis, two factors could predict bad seizure outcome - the occurrence of other seizures in addition to infantile spasms and no response to 28 days of adrenocorticotropic hormone (ACTH). No predictor could be identified for abnormal psychomotor development.
Discussion And Conclusion:
In our study, we could demonstrate two factors that predict seizure freedom. The cognitive outcome and seizure control in this group of children are comparable to the existing literature. However, the cognitive outcome revealed by our study and the survey of the literature are discouraging.
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