Management of infantile spasms

Early diagnosis and treatment of IS is very important since it results in improved neurodevelopment of the infant (1,2).

Pharmacological treatment of infantile spasms (3)

• First-line treatment in infants with infantile spasms
  • discuss with, or refer to, a tertiary paediatric epilepsy specialist when an infant presents with infantile spasms
  • a steroid (prednisolone or tetracosactide) or vigabatrin should be offered as first-line treatment to infants with infantile spasms that are not due to tuberous sclerosis
  • vigabatrin should be offered as first-line treatment to infants with infantile spasms due to tuberous sclerosis. If vigabatrin is ineffective, offer a steroid (prednisolone or tetracosactide)

Other treatment options

• ketogenic diet
  • often used in intractable or profound epilepsies, including infantile spasms, with or without the concurrent use of medications
  • between 14-65% patients were spasm free within 1-3 month
  • higher efficacy was seen in
    • patients who were treated prior to age of 1 year
    • cryptogenic IS
  • there is inadequate data to recommend this as a sole first line therapy
• resective surgery
  • children who do not respond to first line therapy and with surgical lesions may be considered for epilepsy surgery (1,2)

PET scanning may show hypometabolic lesions which have been excised surgically with relief of symptoms.

Reference:

• (1) Nelson GR. Management of infantile spasms. Transl Pediatr. 2015;4(4):260-70.
• (2) Taghdiri MM, Nemati H. Infantile spasm: a review article. Iran J Child Neurol. 2014;8(3):1-5.
• (3) NICE (April 2004). Newer drugs for epilepsy in children.