Treatment of children with infantile spasms: A network meta-analysis

Area of Science:

• Pediatric Neurology
• Pharmacology
• Clinical Trials

Background:

• Infantile spasms are a rare and severe epilepsy syndrome in infants.
• Early diagnosis and treatment are crucial for improving outcomes.
• Non-surgical interventions are the mainstay of treatment, but comparative effectiveness data are limited.

Purpose of the Study:

• To systematically review and perform a network meta-analysis (NMA) of non-surgical interventions for infantile spasms.
• To provide comparative effectiveness estimates and rankings for first-line treatments.
• To identify the most effective interventions for achieving remission.

Main Methods:

• Systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs).
• Included RCTs involved children aged 2 months to 3 years with infantile spasms.
• Analyzed electroclinical and clinical remission rates within one month of treatment initiation.

Main Results:

• Seventeen RCTs were included in the NMA, comparing various first-line treatments.
• For electroclinical remission, high-dose ACTH, methylprednisolone, low-dose ACTH/MgSO4, low-dose ACTH, and high-dose prednisolone were ranked highest.
• For clinical remission, low-dose ACTH/MgSO4, high-dose ACTH, high-dose prednisolone, and low-dose ACTH were ranked highest.

Conclusions:

• Adrenocorticotropic hormone (ACTH) and high-dose prednisolone are more effective in achieving both electroclinical and clinical remissions for infantile spasms.
• These treatments demonstrate superior efficacy compared to other non-surgical options.
• Symptomatic etiology negatively impacts remission likelihood, even when accounting for treatment lag.