Abstracts

Rationale: Hormonal therapy is recommended as first line treatment for epileptic spasms (ES). Anecdotally, some have reported better outcomes regarding spasm cessation and developmental outcomes with hormonal therapy in combination with topiramate. We reviewed our experience using hormonal treatment (adrenocorticotropic hormone (ACTH) or prednisolone; HT) alone or in combination with topiramate, determining whether one treatment was more effective in controlling spasms. As a secondary outcome, we evaluated whether the treatments effected development. Methods: This is an IRB-approved, retrospective chart review of ES patients diagnosed between 1/1/2008 and 12/31/2014 at Phoenix Children's Hospital. Data collected included: gender; age; etiology; electroencephalographic and imaging findings; treatment; spasms resolution at 1, 6, and 12 months after treatment initiation; and presence of developmental delay 1 year after treatment initiation. Patients were subdivided into: idiopathic versus symptomatic etiology; hormonal treatment alone versus in combination with topiramate (begun within 1 month of hormonal therapy initiation); (CT). Data were analyzed using a Pearson chi-squared test to determine whether spasm resolution differed between treatment groups. Comparisons were made at each time point using only those patients, who still had data available at those times. For idiopathic spasms the presence of developmental delay 1 year after treatment initiation was compared between treatment groups using the Pearson chi-squared test. Results: One hundred and five ES patients were identified. CT proved to be the most common therapy (37/105). Fifty patients were excluded due to: no initial follow up; missing data elements; or use of other treatments. Fifty-five patients met inclusion criteria (Table 1), of whom 28 (51%) were symptomatic, while 27 (49%) were idiopathic. Forty-six patients were followed through 12 months for seizure outcomes. We had documentation describing developmental outcomes at 12 months from treatment initiation for 49 patients. Thirty-seven patients (67%) were treated with CT, while 18 patients (33%) were treated with HT. There was no statistically significant difference in type of treatment used for spasm etiology (p-value = 0.21). Whether comparing all patients, only those with idiopathic spasms, or only those with symptomatic spasms, there was not a statistically significant difference in spasms resolution between HT and CT treatment at any time point (p?-0.12 for all): 1, 6, or 12 months. In order to identify the most likely benefit of a particular spasm therapy on preservation of normal development, we compared the presence of developmental delay in those with idiopathic spasms 1 year after treatment initiation, when treated with HT or CT. There was not a statistically significant difference in the presence of developmental delays at 12 months between treatment groups (p = 0.34, Table 2). Conclusions: Combination therapy was the most common treatment paradigm at our institution for epileptic spasms. However, there was no difference in spasm resolution when comparing HT or CT treatment, even 12 months later. There was also no difference in the presence of developmental delay at 12 months between the 2 treatments. We acknowledge several limitations to our study. Due to the retrospective nature of our study, patients were lost to follow-up or did not receive HT or CT initially. The hormonal agent and its dosing, as well as the topiramate dosing, varied. The initiation of topiramate was not always concomitant with hormonal treatment at diagnosis. A prospective investigation of outcomes in epileptic spasms treated with HT or CT with a standardized protocol might demonstrate a significant benefit. Funding: none