Abstracts

Rationale: Infantile spasm is a well-known epilepsy syndrome since Dr. West described unique behavior of his own son on 1841. It develops clinical spasm with unique EEG finding of hypsarrhythmia at a particular age usually around 5 months. This malignant epilepsy syndrome is notorious that there are few drugs thought to be effective: ACTH; oral steroid; and vigabatrin. Besides of these pharmacological treatments, there is also an effective non-pharmacological treatment for epilepsy, the ketogenic diet. Since Charlie s story introduced in 1994, this special diet has been providing its probability to treat and cure various types of epilepsies, including infantile spasm. Comparing the efficacy of ketogenic diet and that of oral steroid may be beneficial to suggest which treatment should be considered first.Methods: We reviewed 404 patients with infantile spasm as a pilot study who visitied epilepsy center of Severance Hospital from 2003 to 2011. Patients who underwent epilepsy surgery or treated with more than four anti-epileptic drugs (n=180) were excluded. Among the rest of patient, 148 patients were not either treated with oral steroid or ketogenic diet. The rest patients (n=76) were categorized into three groups of: ketogenic only (group 1); oral steroid only (group 2); and both of ketogenic diet and oral steroid (group 3).Results: There were 37 patients in group 1; 29 in group 2; and 10 in group 3. The number of AEDs were 2.4 (group 1); 2.1 (group 2); and 2.5 (group 3). In group 1, nine of 40 patients were seizure free. One thirds of patients (12/36) in group 2 were seizure free. Overall seizure free rate was 10/47 (21.3%) in patients who treated with ketogenic diet and 13/39 (33.3%) with oral steroid. Conclusions: The seizure free rate was higher in patients who treated with oral steroid as an adjunctive study. This is a pilot study and some variables were not investigated yet, such as interval date from treatment onset and seizure free. The number of patients who experienced markedly reduced seizures was not investigated. Those will be reported soon to suggest which modality is more superiorly applicable to treat patient with infantile spasm.