Abstracts

Rationale: Infantile spasms (IS) is an epileptic encephalopathy of infancy and early childhood, which is usually associated with an electroencephalographic pattern (EEG) of hypsarrhythmia. The incidence of IS ranges from 2-3.5 per 10000 live births (Pellock et al. 2010). According to one study, the rate of remission at 12 month without treatment is 25%; however, only 9% of patients show normal development (Hrachovy et al. 1991). The main stay of therapy for IS is high dose adrenocorticotropic hormone (ACTH). A recent guideline of the Child Neurology Society (Go et al. 2012) concluded that there is not enough evidence to determine if other forms of corticosteroids are effective. In this study we present a review of our experience at WFBMC with use of ACTH and high dose oral prednisolone in the treatment of IS. Methods: This is a retrospective observational study of management of IS with high dose oral prednisolone or ACTH at our institution between 2009 and 2014. A search of electronic medical records was undertaken to identify all the patients that were diagnosed with IS based on EEG criteria in the above time period. A total of 34 patients were identified. High dose oral prednisolone or ACTH was used in 29 patients. All patients had a follow up EEG to determine response, 1 to 2 months after the end of therapy. Positive response was defined as resolution of hypsarrhythmia on EEG and resolution of spasms. Patients were treated with either oral prednisolone 15-20mg every eight hours or ACTH 80U IM once a day for two weeks followed by a 4-8 week taper. Results: Of 29 patients, 21 patients were treated with high dose oral prednisolone and 8 with ACTH. 14 (67%) patients demonstrated a positive response to prednisolone and 4 (50%) to ACTH. Conclusions: Based on our experience of treating IS with high dose oral prednisolone, it appears that prednisolone is a viable option for the initial treatment of IS. Considering the cost of a course of ACTH vs high dose oral prednisolone to the patient's family and to the medical system, we believe that patients presenting with new diagnosis of IS should have a trial of prednisolone. Pellock J, et al. (2010). Infantile spasms: A U.S. consensus report. Epilepsia. 51(10):2175-2189. Go, CY, et al. (2012). Evidence-based guideline update: Medical treatment of infantile spasms. Neurology. 78(24):1974-1980. Hrachovy RA, et al. (1991). A retrospective study of spontaneous remission and long-term outcome in patients with infantile spasms. Epilepsia. 32(2):212.