Comparative Study of Symmetric vs Asymmetric Infantile Spasms: A Review on the Clinical Profile and Outcome
Abstract number :
3.206
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2023
Submission ID :
1064
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Jaime Shoup, MD – University of Louisville
ANDREW HEY, MD – University of Louisville; SIDDHARTH JAIN, MD – University of Louisville; CEMAL KARAKAS, MD – University of Louisville; SAMIR KARIA, MD – Associate Professor of Child Neurology, Epilepsy, Clinical Neurophysiology, Department of Neurology, University of Louisville; LAUREN PETREY, MD – University of Louisville; JEETENDRA SAH, MD – University of Louisville
Rationale: Infantile spasms demonstrate diverse presentations, including symmetric and asymmetric spasms. Distinguishing between these types could potentially influence diagnosis, treatment approaches, and prognosis. Despite this, there is a paucity of research comparing these two spasm types.
Methods: This study was a retrospective analysis performed at the Norton Children's Hospital (NCH), involving patients diagnosed with infantile spasms between 2015 and 2021. We compared clinical characteristics and outcomes between patients presenting with infantile spasms with symmetric vs asymmetric clinical features. The variables evaluated included age at diagnosis, gender, history of neonatal seizure, lead time to diagnosis, history of regression, developmental delay, MRI findings, localization of spasms on EEG, treatment response, and development of other seizure types. The continuous variables were analyzed using the unpaired t-test, while categorical variables were assessed using the Chi-square test or Fisher's exact test, as appropriate. A p-value of less than 0.05 was considered statistically significant.
Results: A total of 94 patients (Male: Female - 57:37) were included in the study, with 53 presenting with symmetric spasms and 41 with asymmetric spasms. No significant differences were found between the two groups in terms of age of diagnosis, gender distribution, history of neonatal seizures, presence of MRI abnormalities, structural (acquired vs congenital) imaging abnormalities, history regression, developmental delay, and development of other seizure types (all p >0.05). However, significant differences were found in lead time to diagnosis (p=0.02) with an earlier diagnosis in asymmetric spasms, localization of spasms on EEG (p < 0.00001) with focal EEG features being more prominent in asymmetric spasms, response to first-line therapy (p=0.002) with higher response rate in symmetric spasms, and resolution of spasms (p=0.007) being more common in symmetric spasms. Asymmetric spasm patients were diagnosed faster, primarily had focal EEG findings, and had lower treatment response and spasm resolution rates compared to the symmetric spasm group. (Table 1)
Clinical Epilepsy