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The patterns of response of 11 regimens for infantile spasms
Leilei Mao1, Miriam Kessi1, Pan Peng1
1Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.
Insights
Early treatment of infantile spasms (ISs) with first-line therapies significantly improves seizure freedom rates. Delaying these treatments reduces their effectiveness, highlighting the importance of timely intervention for this epilepsy form.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Therapeutics
Background:
- Infantile spasms (ISs) represent a severe form of early infantile epileptic encephalopathy.
- Optimal treatment strategies and the impact of treatment timing on outcomes remain incompletely understood.
Purpose of the Study:
- To investigate the response patterns of various therapeutic regimens in infantile spasms.
- To compare seizure freedom rates between patients receiving early versus delayed first-line therapies.
Main Methods:
- Retrospective analysis of 314 infantile spasms cases.
- Evaluation of the efficacy of 11 different treatment regimens.
- Comparison of outcomes based on the timing of first-line therapy administration.
Main Results:
- The efficacy of sequential regimens showed diminishing returns: first two regimens (36.99%), third (10.27%), fourth (6.16%), fifth (5.48%).
- Regimens from the sixth onwards added less than 2% probability of seizure freedom each.
- A statistically significant difference in seizure freedom was observed favoring early administration of first-line therapies.
Conclusions:
- Seizure freedom in infantile spasms is most likely achieved within the first five treatment regimens.
- Early administration of first-line therapies is demonstrably superior to initiating treatment with non-first-line options.
- Findings support timely initiation of first-line treatments for improved infantile spasms management.
Abstract:
Infantile spasms (ISs) is a devastating form of an early infantile epileptic encephalopathy. The patterns of response of multiple regimens, and the difference in response rates for the cases who receive first-line therapies on time versus those who receive them after non-first-line therapies are unknown. We performed a study involving 314 ISs cases aiming to investigate the patterns of response of 11 regimens, and the difference in response rates for the cases received first-line therapies as first two regimens versus those who received other drugs prior to first-line options. As a result, the efficacy of each regimen was: the foremost two regimens; 36.99%, third; 10.27%, fourth; 6.16%, fifth; 5.48%, and from the sixth regimen onwards, each additional regimen added ≤ 2% probability of seizure freedom. There was a statistically significant difference in seizure freedom rates between cases received first-line therapies as first or second regimen versus those who received them later. Our study revealed for the first time that in ISs cases, seizure freedom is likely to be observed within the first five regimens, and an early administration of first-line therapies is superior to non-first-line options. These results will aid in management of ISs cases.
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