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Efficacy of Treatments for Infantile Spasms: A Systematic Review
Ji Min Song1, Jongsung Hahn, Se Hee Kim
1*Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, †Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, and ‡Department of Pediatrics, College of Medicine, Yonsei University, Incheon; and §Division of Pediatric Neurology, Severance Children's Hospital, Seoul, Republic of Korea.
Insights
West syndrome, a rare infant epilepsy, has limited treatment data. Promising alternatives like topiramate and ketogenic diets exist alongside standard therapies, but more research is needed.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Pharmacology
Background:
- West syndrome, characterized by infantile spasms, is a rare and challenging pediatric epilepsy.
- Current first-line treatments include adrenocorticotropic hormone (ACTH) steroids and vigabatrin.
- Despite existing treatments, West syndrome remains difficult to manage effectively.
Purpose of the Study:
- To systematically review the literature from the past decade on West syndrome treatments.
- To provide an overview of current therapeutic options for infantile spasms.
- To identify potential alternative or supplementary treatments for West syndrome.
Main Methods:
- A systematic literature search was conducted in PubMed and EMBASE.
- Studies published between 2005 and 2015 involving human patients diagnosed with infantile spasms were included.
- Interventions focused on drug and diet treatments for West syndrome.
Main Results:
- Fifty-five studies were included, comprising meta-analyses, randomized controlled trials, and observational studies.
- Besides ACTH steroids and vigabatrin, potential drug treatments include topiramate, levetiracetam, zonisamide, and sodium valproate with benzodiazepines.
- Dietary interventions such as ketogenic diet and modified Atkins diet showed effectiveness.
Conclusions:
- Evidence on the efficacy of West syndrome treatments remains limited.
- Topiramate and ketogenic diet show promise as alternative or adjunctive therapies.
- Further well-designed clinical trials are necessary to validate these findings and guide treatment strategies.
Objectives:
West syndrome (also known as infantile spasm because of its main seizure type) is a rare form of epilepsy that begins during early infancy. Recent guidelines and reviews on West syndrome recommend the use of adrenocorticotropic hormone steroids, or vigabatrin, as the first-line treatment. However, West syndrome remains to be one of the most challenging epilepsies to treat. Here, we systematically reviewed the current literature obtained during the previous decade. This article provides an overview of the current treatment of infantile spasms.
Methods:
PubMed and EMBASE were searched to retrieve studies on human published during 2005-2015 and to identify patients with clinical diagnosis of infantile spasms. Drug or diet treatments were used as interventions and comparators.
Results:
We included 55 studies, of which 1 study was a meta-analysis, 9 were randomized controlled trials, 21 were prospective studies, and 24 were retrospective studies. Topiramate, levetiracetam, zonisamide, and sodium valproate with benzodiazepine (clonazepam or nitrazepam) were found to be potential drugs for treating West syndrome besides adrenocorticotropic hormone, steroids, and vigabatrin. Ketogenic diet and modified Atkins diet were also found to be effective.
Conclusions:
To date, data regarding the efficacy of treatments of West syndrome still remain limited. Some treatments, including topiramate and ketogenic diet, seem promising besides adrenocorticotropic hormone, steroids, and vigabatrin. Well-designed trials are warranted to validate the findings.
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