Abstracts

Rationale: Infantile spasms (IS) is an age dependent epileptic encephalopathy associated with high risk of adverse developmental outcome. The AAN practice parameter(2004)states that ACTH is probably effective short-term. The recent U.S. consensus report on IS (2010) upholds the use of ACTH as first line treatment. Over the last few years high dose oral prednisolone has been found to be effective in treatment of IS. We report three cases of IS treated with high dose oral prednisolone with excellent short term results.Methods: Three infants with infantile spasms and hypsarrhythmia on EEG were treated with high dose oral prednisolone . Each infant was treated for four weeks, two weeks on full dose (4 - 6 mg/kg/day, max 60 mg/day) followed by a two week taper. The following table shows the age at onset of IS, etiology, duration of IS before starting oral prednisolone and the dose used for the first 14 days. Results: The first two patients showed cessation of spasms on day 5 of treatment. The third one was spasm free at day 14. Irritability and weight gain were seen in one infant, while GE-reflux occurred in another. There were no major side effects. EEG upon completion of treatment showed resolution of hypsarrhythmia in all three cases. The duration of follow-up currently ranges between five to 14 months. All three remain seizure free. One is developmentally normal. The other two are making developmental progress but have delays related to the underlying etiology.Conclusions: The response in these three patients is encouraging. Though the number of patients is small, it lends support to recent reports suggesting high dose oral prednisolone as an effective alternative to ACTH for the treatment of infantile spasms. Prospective studies to further evaluate this are needed.