Cognitive outcome in children with infantile spasms using a standardized treatment protocol. A five-year longitudinal study
Related Experiment Video
Updated: Nov 4, 2025
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Jonathan Y Bitton1, Béatrice Desnous2, Hannelore C Sauerwein1
1Ste-Justine Hospital, Department of Pediatrics & Research Center, Canada.
Insights
Children with infantile spasms (IS) show cognitive improvement over five years. Etiology is key, with no identified cause predicting better outcomes, while symptomatic causes indicate poorer development.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
- Clinical Pediatrics
Background:
- Infantile spasms (IS) are a severe epilepsy syndrome in infants.
- Long-term developmental outcomes and influencing factors require further investigation.
Purpose of the Study:
- To assess the 5-year developmental trajectory in children treated for IS.
- To identify clinical factors predicting cognitive outcomes in IS patients.
Main Methods:
- Analysis of a 5-year follow-up (3 years open-label) of 41 children from a prior IS randomized controlled trial.
- Cognitive assessment using Vineland Adaptive Behavior Scale and Stanford-Binet/Bayley Scales.
Main Results:
- Etiology significantly predicted cognitive outcome; no identified etiology (NIE) showed progressive improvement.
- Symptomatic etiology, developmental delay, other seizure types, and persistent EEG abnormalities predicted poorer outcomes.
- Cognitive function improved between 2 and 5 years post-diagnosis, particularly in the NIE group.
Conclusions:
- Children with IS demonstrate potential for cognitive improvement up to 5 years post-diagnosis.
- Developmental assessment before school entry is recommended for all children with IS.
- Thorough etiological investigation and evidence-based treatment are crucial for optimizing cognitive outcomes.
Aim:
To evaluate the long-term developmental trajectory of children with infantile spasms (IS) and identify the clinical protective and risk factors associated with their cognitive outcome.
Methods:
We analyzed the five-year follow-up results of 41 children (13 female) from the previously published cohort (n = 68) recruited in a multicenter randomized controlled trial for 2-years, examining the effect of an adjunctive therapy (Flunarizine) on standardized IS treatment. The children were subsequently monitored in an open-label study for additional 3 years. The Vineland Adaptive Behavior Scale, second edition, and either the Stanford-Binet Intelligence Scale, Fifth Edition (SB5) or the Bayley Scales of Infant Development, second edition (BSID-II) were used as cognitive outcome measures.
Results:
Etiology was the strongest predictor of outcome. Children with no identified etiology (NIE) showed a progressive improvement of cognitive functions, mostly occurring between 2 and 5 years post-diagnosis. Conversely, symptomatic etiology was predictive of poorer cognitive outcome. Developmental delay, other seizure types (before and after IS diagnosis), and persistent electroencephalographic abnormalities following treatment were predictive of poor cognitive outcome.
Interpretation:
Given the 5-year cognitive improvement, children with IS should undergo a developmental assessment before school entry. Factors influencing their cognitive outcome emphasize the importance of thorough investigation and evidence-based treatment.
