Abstracts

Rationale: Infantile Spasms is one of the most frequent epileptic encephalopathy (incidence of 2 to 3 per 10000 live births), most with a catastrophic prognosis that has been associated with hypsarrhythmia in the electroencephalogram (EEG). Methods: Longitudinal descriptive study. Medical charts of hospitalized infants with diagnosis of symptomatic/idiopathic epilepsy, west syndrome, focal or generalized seizures and epileptic spasms in the Hospital de la Misericordia, a pediatric hospital in Bogota, Colombia, were reviewed from 2007 to 2012. Patients with epileptic spasms clinically observed or by videoEEG were selected. Charts of outpatient follow up were also reviewed. The mean follow up was 7 months (1 to 49months) The Kramer scale (1997) was used to score the EEG, and define the hypsarrhythmia and no hypsarrhythmia patterns. The statistic analysis was performed using SPSS17.0. Results: 251 patients were initially selected. Of them, 39 had epileptic spasms. 4 patients were excluded because of the lack of EEG or videoEEG. 63% were male, with mean age 7.6 months (1-21months). 71% of patients had another type of seizure, most of them focal (68%). The symptomatic etiology was the most frequent with hypoxic ischemic encephalopathy (32%), malformation of cortical development (28.6%), other CNS malformations (10.7%), meningitis (10.7%), inborn error of metabolism 7% (Leigh disease and nonketotic hyperglycinemia) and 10.7% had symptomatic unknown etiology. Hypsarrhythmia was documented in 57% (mean score in Kramer scale: 10.8 points vs 5.2 points in patients without hypsarrhythmia). There were no differences between groups in age of onset of spasms (5.7 vs 4.6 - with hypsarrhythmia/without hypsarrhythmia, p=NS), symptomatic etiology (75% vs 86% p=NS), type of spasms (symmetric 80% vs 87%, in flexion 60% vs 66%), nor abnormal magnetic resonance imaging (75 vs 86% p=NS). There were no differences in control of spasms and hypsarrhythmia or etiology. The no hypsarrhythmia patterns were paroxysmal delta waves (80%), generalized slowing (73%), focal spikes (40%), multifocal spikes (33%), interhemyspheric asymmetry (26%) and normal EEG (7%). There was significant relation between poor control of spasms and other seizures with focal spikes in EEG (uncontrolled spasms with focal spikes 83.3% vs 16%; uncontrolled seizures 100% vs 0%, p=0.05). Conclusions: In this study there was no relation between neurological outcome, seizures control and hypsarrhythmia. However, we report an association between other EEG patterns and control of spasms as well as other seizures. It is very important to describe that in these patients the infantile spasms are an encephalopathy with neurological prognosis and control of seizures influenced also by EEG patterns other than hypsarrhythmia. So, we should focus the treatment on control of spasms, hypsarrhythmia and other epileptic discharges too. Although it is necessary include the patients in a prospective study.