Abstracts

Rationale: To review in a retrospective fashion our clinical experience with treatment of infantile spasms and their developmental outcome. Methods: We did a retrospective chart review of a total of 28 patients identified with infantile spasms from 2001 to 2007. Results: In the 28 patients reviewed, 14 patients (50%) were identified with symptomatic infantile spasms and 14 patients (50%) were identified with cryptogenic or idiopathic infantile spasms. The different etiologies associated with symptomatic infantile spasms included 1 genetic cause (7%) , 1 infectious cause (7%), 4 anoxic brain injuries during birth or soon after birth (29%), 8 structural lesions (57%). The mean age of onset was 8 months (range between 3 weeks and 13 months). Of these patients, 13/28 (46%) had presented at less than 6 months of age, 12/28 (43%) presented between 6 and 12 months of age, and 3/28 (11%) presented after 1 year of age. To manage infantile spasms, different medications were used. Of the 28 patients, 11 (39%) were treated with ACTH, 5 (18%) were treated with Phenobarbital, 3 (10.7%) were treated with Valproic Acid, 2 (7.2%) were treated with Tegretol, 1 (3.6%) was treated with Zonegran, and 1 (3.5%) was treated with Topamax (3.6%). 4 patients (14.3%) required multiple antiepileptic drugs and 1 patient (3.6%) was not placed on treatment as per the families request secondary to infrequent spasms. ACTH was effective in resolving spasms completely with no known recurrence in 8 out of 9 patients. One patient had recurrence of spasms after 3 months spasm-free. Of those 7 patients with no recurrence of spasms, 5 patients had normal development and 2 had minor developmental delays. Infantile spasms in patients treated with other antiepileptic medications were not as well controlled and the patients had more significant developmental delays. Patients that were refractory to treatment and on multiple antiepileptic medications and patients that failed on ACTH had the most significant delays. Conclusions: Infantile spasms are a childhood epilepsy syndrome with multiple possible etiologies that do not respond well to standard antiepileptic drugs. ACTH has been found to be effective for the short term treatment of infantile spasms and in resolution of hypsarrhythmia. In our study, it was found that patients treated early with ACTH who obtained complete resolution of spasms did better developmentally than patients treated with other medications.