Download PDF
Semin Neurol 2020; 40(02): 236-245
DOI: 10.1055/s-0040-1705121
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Infantile Spasms: Opportunities to Improve Care

Ricka Messer 
1   Department of Pediatrics and Neurology, University of Colorado, Aurora, Colorado
,
Kelly G. Knupp
1   Department of Pediatrics and Neurology, University of Colorado, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

Publication Date:
06 March 2020 (online)

   Permissions and Reprints

Abstract

Infantile spasm (IS) is a distinct epilepsy syndrome characterized by epileptic spasms (the clinical seizure type) and hypsarrhythmia (the electrographic abnormality). IS is frequently accompanied by impaired neurodevelopment and is often associated with structural, genetic, or metabolic etiologies. Prompt treatment of this severe epileptic encephalopathy improves long-term outcomes but remains elusive in many situations. Despite common misconceptions, even patients with identified etiologies or preexisting developmental delay benefit from proven standard therapies, including adrenocorticotropic hormone (ACTH), oral corticosteroids, or vigabatrin. Treatment efficacy should be assessed with electroencephalography at 2 weeks, and an alternative therapy is indicated if epileptic spasms or hypsarrhythmia have not resolved. Collaboration with primary care providers is critical to mitigate the potentially serious adverse effects of standard treatments and also to provide developmental interventions. Although new approaches are on the horizon, addressing current challenges and opportunities now can dramatically improve patient outcomes.

Keywords

infantile spasms - West syndrome - adrenocorticotropic hormone - prednisolone - vigabatrin
 

  • References

  • 1 West W. On a particular form of infantile convulsions. Lancet 1841; 1: 724-725
    CrossrefPubMedGoogle Scholar
  • 2 Fisher RS, Cross JH, French JA. , et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58 (04) 522-530
    CrossrefPubMedGoogle Scholar
  • 3 Lux AL, Osborne JP. A proposal for case definitions and outcome measures in studies of infantile spasms and West syndrome: consensus statement of the West Delphi group. Epilepsia 2004; 45 (11) 1416-1428
    CrossrefPubMedGoogle Scholar
  • 4 Trevathan E, Murphy CC, Yeargin-Allsopp M. The descriptive epidemiology of infantile spasms among Atlanta children. Epilepsia 1999; 40 (06) 748-751
    CrossrefPubMedGoogle Scholar
  • 5 Jia JL, Chen S, Sivarajah V, Stephens D, Cortez MA. Latitudinal differences on the global epidemiology of infantile spasms: systematic review and meta-analysis. Orphanet J Rare Dis 2018; 13 (01) 216
    CrossrefPubMedGoogle Scholar
  • 6 Cowan LD, Hudson LS. The epidemiology and natural history of infantile spasms. J Child Neurol 1991; 6 (04) 355-364
    CrossrefPubMedGoogle Scholar
  • 7 Riikonen R. Epidemiological data of West syndrome in Finland. Brain Dev 2001; 23 (07) 539-541
    CrossrefPubMedGoogle Scholar
  • 8 Kurokawa T, Goya N, Fukuyama Y, Suzuki M, Seki T, Ohtahara S. West syndrome and Lennox-Gastaut syndrome: a survey of natural history. Pediatrics 1980; 65 (01) 81-88
    PubMedGoogle Scholar
  • 9 Riikonen R, Donner M. ACTH therapy in infantile spasms: side effects. Arch Dis Child 1980; 55 (09) 664-672
    CrossrefPubMedGoogle Scholar
  • 10 Bednarek N, Motte J, Soufflet C, Plouin P, Dulac O. Evidence of late-onset infantile spasms. Epilepsia 1998; 39 (01) 55-60
    PubMedGoogle Scholar
  • 11 Donat JF, Wright FS. Simultaneous infantile spasms and partial seizures. J Child Neurol 1991; 6 (03) 246-250
    CrossrefPubMedGoogle Scholar
  • 12 Talwar D, Baldwin MA, Hutzler R, Griesemer DA. Epileptic spasms in older children: persistence beyond infancy. Epilepsia 1995; 36 (02) 151-155
    CrossrefPubMedGoogle Scholar
  • 13 Auvin S, Hartman AL, Desnous B. , et al. Diagnosis delay in West syndrome: misdiagnosis and consequences. Eur J Pediatr 2012; 171 (11) 1695-1701
    CrossrefPubMedGoogle Scholar
  • 14 Hussain SA, Lay J, Cheng E, Weng J, Sankar R, Baca CB. Recognition of infantile spasms is often delayed: the ASSIST study. J Pediatr 2017; 190: 215-221.e1
    CrossrefPubMedGoogle Scholar
  • 15 Gibbs FA, Gibbs EL. Atlas of Electroencephalography. Reading, MA: Addison-Wesley; 1952
    Google Scholar
  • 16 Hussain SA, Kwong G, Millichap JJ. , et al. Hypsarrhythmia assessment exhibits poor interrater reliability: a threat to clinical trial validity. Epilepsia 2015; 56 (01) 77-81
    CrossrefPubMedGoogle Scholar
  • 17 Mytinger JR, Hussain SA, Islam MP. , et al. Improving the inter-rater agreement of hypsarrhythmia using a simplified EEG grading scale for children with infantile spasms. Epilepsy Res 2015; 116: 93-98
    CrossrefPubMedGoogle Scholar
  • 18 Granström ML, Gaily E, Liukkonen E. Treatment of infantile spasms: results of a population-based study with vigabatrin as the first drug for spasms. Epilepsia 1999; 40 (07) 950-957
    CrossrefPubMedGoogle Scholar
  • 19 Riikonen R. A long-term follow-up study of 214 children with the syndrome of infantile spasms. Neuropediatrics 1982; 13 (01) 14-23
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Demarest ST, Shellhaas RA, Gaillard WD. , et al; Pediatric Epilepsy Research Consortium. The impact of hypsarrhythmia on infantile spasms treatment response: observational cohort study from the National Infantile Spasms Consortium. Epilepsia 2017; 58 (12) 2098-2103
    CrossrefPubMedGoogle Scholar
  • 21 Howitz P, Platz P. Infantile spasms and HLA antigens. Arch Dis Child 1978; 53 (08) 680-682
    CrossrefPubMedGoogle Scholar
  • 22 Hrachovy RA, Frost Jr JD, Kellaway P. Hypsarrhythmia: variations on the theme. Epilepsia 1984; 25 (03) 317-325
    CrossrefPubMedGoogle Scholar
  • 23 Sumanasena SP, Wanigasinghe J, Arambepola C, Sri Ranganathan S, Muhandiram E. Developmental profile at initial presentation in children with infantile spasms. Dev Med Child Neurol 2019; 61 (11) 1295-1301
    CrossrefPubMedGoogle Scholar
  • 24 O'Callaghan FJ, Lux AL, Darke K. , et al. The effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: evidence from the United Kingdom Infantile Spasms Study. Epilepsia 2011; 52 (07) 1359-1364
    CrossrefPubMedGoogle Scholar
  • 25 O'Callaghan FJK, Edwards SW, Alber FD. , et al; International Collaborative Infantile Spasms Study (ICISS) investigators. Vigabatrin with hormonal treatment versus hormonal treatment alone (ICISS) for infantile spasms: 18-month outcomes of an open-label, randomised controlled trial. Lancet Child Adolesc Health 2018; 2 (10) 715-725
    PubMedGoogle Scholar
  • 26 Knupp KG, Leister E, Coryell J. , et al; Pediatric Epilepsy Research Consortium. Response to second treatment after initial failed treatment in a multicenter prospective infantile spasms cohort. Epilepsia 2016; 57 (11) 1834-1842
    CrossrefPubMedGoogle Scholar
  • 27 Wang CJ, Jonas R, Fu CM, Ng CY, Douglass L. Quality-of-care indicators for infantile spasms. J Child Neurol 2013; 28 (01) 13-20
    CrossrefPubMedGoogle Scholar
  • 28 Patel AD, Berg AT, Billinghurst L. , et al. Quality improvement in neurology: Child neurology quality measure set: executive summary. Neurology 2018; 90 (02) 67-73
    CrossrefPubMedGoogle Scholar
  • 29 Pellock JM, Hrachovy R, Shinnar S. , et al. Infantile spasms: a U.S. consensus report. Epilepsia 2010; 51 (10) 2175-2189
    CrossrefPubMedGoogle Scholar
  • 30 Wilmshurst JM, Gaillard WD, Vinayan KP. , et al. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia 2015; 56 (08) 1185-1197
    CrossrefPubMedGoogle Scholar
  • 31 Paciorkowski AR, Thio LL, Dobyns WB. Genetic and biologic classification of infantile spasms. Pediatr Neurol 2011; 45 (06) 355-367
    CrossrefPubMedGoogle Scholar
  • 32 Wirrell EC, Shellhaas RA, Joshi C, Keator C, Kumar S, Mitchell WG. ; Pediatric Epilepsy Research Consortium. How should children with West syndrome be efficiently and accurately investigated? Results from the National Infantile Spasms Consortium. Epilepsia 2015; 56 (04) 617-625
    CrossrefPubMedGoogle Scholar
  • 33 Poulat AL, Lesca G, Sanlaville D. , et al. A proposed diagnostic approach for infantile spasms based on a spectrum of variable aetiology. Eur J Paediatr Neurol 2014; 18 (02) 176-182
    CrossrefPubMedGoogle Scholar
  • 34 Osborne JP, Lux AL, Edwards SW. , et al. The underlying etiology of infantile spasms (West syndrome): information from the United Kingdom Infantile Spasms Study (UKISS) on contemporary causes and their classification. Epilepsia 2010; 51 (10) 2168-2174
    CrossrefPubMedGoogle Scholar
  • 35 Salar S, Moshé SL, Galanopoulou AS. Metabolic etiologies in West syndrome. Epilepsia Open 2018; 3 (02) 134-166
    CrossrefPubMedGoogle Scholar
  • 36 Mackay MT, Weiss SK, Adams-Webber T. , et al; American Academy of Neurology; Child Neurology Society. Practice parameter: medical treatment of infantile spasms: report of the American Academy of Neurology and the Child Neurology Society. Neurology 2004; 62 (10) 1668-1681
    CrossrefPubMedGoogle Scholar
  • 37 Go CY, Mackay MT, Weiss SK. , et al; Child Neurology Society; American Academy of Neurology. Evidence-based guideline update: medical treatment of infantile spasms. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2012; 78 (24) 1974-1980
    CrossrefPubMedGoogle Scholar
  • 38 Hancock EC, Osborne JP, Edwards SW. Treatment of infantile spasms. Cochrane Database Syst Rev 2013; (06) CD001770
    PubMedGoogle Scholar
  • 39 Knupp KG, Coryell J, Nickels KC. , et al; Pediatric Epilepsy Research Consortium. Response to treatment in a prospective national infantile spasms cohort. Ann Neurol 2016; 79 (03) 475-484
    CrossrefPubMedGoogle Scholar
  • 40 Low NL. Infantile spasms with mental retardation. II. Treatment with cortisone and adrenocorticotropin. Pediatrics 1958; 22 (06) 1165-1169
    PubMedGoogle Scholar
  • 41 Sorel L, Dusaucy-Bauloye A. [Findings in 21 cases of Gibbs' hypsarrhythmia; spectacular effectiveness of ACTH]. Acta Neurol Psychiatr Belg 1958; 58 (02) 130-141
    PubMedGoogle Scholar
  • 42 Brunson KL, Eghbal-Ahmadi M, Baram TZ. How do the many etiologies of West syndrome lead to excitability and seizures? The corticotropin releasing hormone excess hypothesis. Brain Dev 2001; 23 (07) 533-538
    CrossrefPubMedGoogle Scholar
  • 43 Jaseja H, Jaseja B, Badaya S, Tonpay P. Superior therapeutic efficacy of adrenocorticotrophic hormone (ACTH) in infantile spasms: emerging evidence. Epilepsy Behav 2012; 25 (02) 250
    CrossrefPubMedGoogle Scholar
  • 44 Lux AL, Edwards SW, Hancock E. , et al. The United Kingdom Infantile Spasms Study comparing vigabatrin with prednisolone or tetracosactide at 14 days: a multicentre, randomised controlled trial. Lancet 2004; 364 (9447): 1773-1778
    CrossrefPubMedGoogle Scholar
  • 45 Baram TZ, Mitchell WG, Tournay A, Snead OC, Hanson RA, Horton EJ. High-dose corticotropin (ACTH) versus prednisone for infantile spasms: a prospective, randomized, blinded study. Pediatrics 1996; 97 (03) 375-379
    PubMedGoogle Scholar
  • 46 Hrachovy RA, Frost Jr JD, Kellaway P, Zion TE. Double-blind study of ACTH vs prednisone therapy in infantile spasms. J Pediatr 1983; 103 (04) 641-645
    CrossrefPubMedGoogle Scholar
  • 47 Hussain SA, Shinnar S, Kwong G. , et al. Treatment of infantile spasms with very high dose prednisolone before high dose adrenocorticotropic hormone. Epilepsia 2014; 55 (01) 103-107
    CrossrefPubMedGoogle Scholar
  • 48 Yi ZS, Wu HP, Yu XY, Chen Y, Zhong JM. Efficacy and tolerability of high-dose prednisone in Chinese children with infantile spasms. Brain Dev 2015; 37 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 49 Gonzalez-Giraldo E, Stafstrom CE, Stanfield AC, Kossoff EH. Treating infantile spasms with high-dose oral corticosteroids: a retrospective review of 87 children. Pediatr Neurol 2018; 87: 30-35
    CrossrefPubMedGoogle Scholar
  • 50 Chiron C, Dulac O, Beaumont D, Palacios L, Pajot N, Mumford J. Therapeutic trial of vigabatrin in refractory infantile spasms. J Child Neurol 1991; (Suppl. 02) S52-S59
    PubMedGoogle Scholar
  • 51 Vigevano F, Cilio MR. Vigabatrin versus ACTH as first-line treatment for infantile spasms: a randomized, prospective study. Epilepsia 1997; 38 (12) 1270-1274
    CrossrefPubMedGoogle Scholar
  • 52 Appleton RE, Peters AC, Mumford JP, Shaw DE. Randomised, placebo-controlled study of vigabatrin as first-line treatment of infantile spasms. Epilepsia 1999; 40 (11) 1627-1633
    CrossrefPubMedGoogle Scholar
  • 53 Elterman RD, Shields WD, Mansfield KA, Nakagawa J. ; US Infantile Spasms Vigabatrin Study Group. Randomized trial of vigabatrin in patients with infantile spasms. Neurology 2001; 57 (08) 1416-1421
    CrossrefPubMedGoogle Scholar
  • 54 Lux AL, Edwards SW, Hancock E. , et al; United Kingdom Infantile Spasms Study. The United Kingdom Infantile Spasms Study (UKISS) comparing hormone treatment with vigabatrin on developmental and epilepsy outcomes to age 14 months: a multicentre randomised trial. Lancet Neurol 2005; 4 (11) 712-717
    CrossrefPubMedGoogle Scholar
  • 55 Chiron C, Dumas C, Jambaqué I, Mumford J, Dulac O. Randomized trial comparing vigabatrin and hydrocortisone in infantile spasms due to tuberous sclerosis. Epilepsy Res 1997; 26 (02) 389-395
    CrossrefPubMedGoogle Scholar
  • 56 Hong AM, Turner Z, Hamdy RF, Kossoff EH. Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants. Epilepsia 2010; 51 (08) 1403-1407
    CrossrefPubMedGoogle Scholar
  • 57 Glauser TA, Clark PO, Strawsburg R. A pilot study of topiramate in the treatment of infantile spasms. Epilepsia 1998; 39 (12) 1324-1328
    CrossrefPubMedGoogle Scholar
  • 58 Zou LP, Lin Q, Qin J, Cai FC, Liu ZS, Mix E. ; Topiramate Study Group. Evaluation of open-label topiramate as primary or adjunctive therapy in infantile spasms. Clin Neuropharmacol 2008; 31 (02) 86-92
    CrossrefPubMedGoogle Scholar
  • 59 Weber A, Cole JW, Mytinger JR. Infantile spasms respond poorly to topiramate. Pediatr Neurol 2015; 53 (02) 130-134
    CrossrefPubMedGoogle Scholar
  • 60 Angappan D, Sahu JK, Malhi P, Singhi P. Safety, tolerability, and effectiveness of oral zonisamide therapy in comparison with intramuscular adrenocorticotropic hormone therapy in infants with West syndrome. Eur J Paediatr Neurol 2019; 23 (01) 136-142
    CrossrefPubMedGoogle Scholar
  • 61 Gümüş H, Kumandaş S, Per H. Levetiracetam monotherapy in newly diagnosed cryptogenic West syndrome. Pediatr Neurol 2007; 37 (05) 350-353
    CrossrefPubMedGoogle Scholar
  • 62 Mikati MA, El Banna D, Sinno D, Mroueh S. Response of infantile spasms to levetiracetam. Neurology 2008; 70 (07) 574-575
    CrossrefPubMedGoogle Scholar
  • 63 Auvichayapat N, Tassniyom S, Treerotphon S, Auvichayapat P. Treatment of infantile spasms with sodium valproate followed by benzodiazepines. J Med Assoc Thai 2007; 90 (09) 1809-1814
    PubMedGoogle Scholar
  • 64 O'Callaghan FJ, Edwards SW, Alber FD. , et al; Participating Investigators. Safety and effectiveness of hormonal treatment versus hormonal treatment with vigabatrin for infantile spasms (ICISS): a randomised, multicentre, open-label trial. Lancet Neurol 2017; 16 (01) 33-42
    CrossrefPubMedGoogle Scholar
  • 65 Maguire MJ, Hemming K, Wild JM, Hutton JL, Marson AG. Prevalence of visual field loss following exposure to vigabatrin therapy: a systematic review. Epilepsia 2010; 51 (12) 2423-2431
    CrossrefPubMedGoogle Scholar
  • 66 Westall CA, Wright T, Cortese F, Kumarappah A, Snead III OC, Buncic JR. Vigabatrin retinal toxicity in children with infantile spasms: an observational cohort study. Neurology 2014; 83 (24) 2262-2268
    CrossrefPubMedGoogle Scholar
  • 67 Schwarz MD, Li M, Tsao J. , et al. A lack of clinically apparent vision loss among patients treated with vigabatrin with infantile spasms: the UCLA experience. Epilepsy Behav 2016; 57 (Pt A): 29-33
    CrossrefPubMedGoogle Scholar
  • 68 Hussain SA, Tsao J, Li M. , et al. Risk of vigabatrin-associated brain abnormalities on MRI in the treatment of infantile spasms is dose-dependent. Epilepsia 2017; 58 (04) 674-682
    CrossrefPubMedGoogle Scholar
  • 69 Fong CY, Osborne JP, Edwards SW. , et al. An investigation into the relationship between vigabatrin, movement disorders, and brain magnetic resonance imaging abnormalities in children with infantile spasms. Dev Med Child Neurol 2013; 55 (09) 862-867
    CrossrefPubMedGoogle Scholar
  • 70 Fedak EM, Patel AD, Heyer GL, Wood EG, Mytinger JR. Optimizing care with a standardized management protocol for patients with infantile spasms. J Child Neurol 2015; 30 (10) 1340-1342
    CrossrefPubMedGoogle Scholar
  • 71 Rajaraman RR, Lay J, Alayari A, Anderson K, Sankar R, Hussain SA. Prevention of infantile spasms relapse: zonisamide and topiramate provide no benefit. Epilepsia 2016; 57 (08) 1280-1287
    CrossrefPubMedGoogle Scholar
  • 72 Chipaux M, Dorfmüller G, Fohlen M. , et al. Refractory spasms of focal onset—a potentially curable disease that should lead to rapid surgical evaluation. Seizure 2017; 51: 163-170
    CrossrefPubMedGoogle Scholar
  • 73 Chugani HT, Ilyas M, Kumar A. , et al. Surgical treatment for refractory epileptic spasms: the Detroit series. Epilepsia 2015; 56 (12) 1941-1949
    CrossrefPubMedGoogle Scholar
  • 74 Baba H, Toda K, Ono T, Honda R, Baba S. Surgical and developmental outcomes of corpus callosotomy for West syndrome in patients without MRI lesions. Epilepsia 2018; 59 (12) 2231-2239
    CrossrefPubMedGoogle Scholar
  • 75 Glaze DG, Hrachovy RA, Frost Jr JD, Kellaway P, Zion TE. Prospective study of outcome of infants with infantile spasms treated during controlled studies of ACTH and prednisone. J Pediatr 1988; 112 (03) 389-396
    CrossrefPubMedGoogle Scholar
  • 76 Primec ZR, Kopac S, Neubauer D. Epidemiologic features of infantile spasms in Slovenia. Epilepsia 2002; 43 (02) 183-187
    CrossrefPubMedGoogle Scholar
  • 77 Dulac O, Plouin P, Jambaqué I. Predicting favorable outcome in idiopathic West syndrome. Epilepsia 1993; 34 (04) 747-756
    CrossrefPubMedGoogle Scholar
  • 78 Ito M, Aiba H, Hashimoto K. , et al. Low-dose ACTH therapy for West syndrome: initial effects and long-term outcome. Neurology 2002; 58 (01) 110-114
    CrossrefPubMedGoogle Scholar
  • 79 Hwang YS. ; Korean Child Neurology Society. National survey on West syndrome in Korea. Brain Dev 2001; 23 (07) 565-569
    CrossrefPubMedGoogle Scholar
  • 80 Matsuo A, Matsuzaka T, Tsuru A. , et al. Epidemiological and clinical studies of West syndrome in Nagasaki Prefecture, Japan. Brain Dev 2001; 23 (07) 575-579
    CrossrefPubMedGoogle Scholar
  • 81 Lombroso CT. A prospective study of infantile spasms: clinical and therapeutic correlations. Epilepsia 1983; 24 (02) 135-158
    CrossrefPubMedGoogle Scholar
  • 82 Rantala H, Putkonen T. Occurrence, outcome, and prognostic factors of infantile spasms and Lennox-Gastaut syndrome. Epilepsia 1999; 40 (03) 286-289
    CrossrefPubMedGoogle Scholar
  • 83 Matsumoto A, Watanabe K, Negoro T. , et al. Infantile spasms: etiological factors, clinical aspects, and long term prognosis in 200 cases. Eur J Pediatr 1981; 135 (03) 239-244
    CrossrefPubMedGoogle Scholar
  • 84 Sidenvall R, Eeg-Olofsson O. Epidemiology of infantile spasms in Sweden. Epilepsia 1995; 36 (06) 572-574
    CrossrefPubMedGoogle Scholar
  • 85 Riikonen R, Amnell G. Psychiatric disorders in children with earlier infantile spasms. Dev Med Child Neurol 1981; 23 (06) 747-760
    PubMedGoogle Scholar
  • 86 Askalan R, Mackay M, Brian J. , et al. Prospective preliminary analysis of the development of autism and epilepsy in children with infantile spasms. J Child Neurol 2003; 18 (03) 165-170
    CrossrefPubMedGoogle Scholar
  • 87 Wheless JW, Gibson PA, Rosbeck KL. , et al. Infantile spasms (West syndrome): update and resources for pediatricians and providers to share with parents. BMC Pediatr 2012; 12: 108
    CrossrefPubMedGoogle Scholar
  • 88 Hussain SA. Treatment of infantile spasms. Epilepsia Open 2018; 3 (Suppl. 02) 143-154
    CrossrefPubMedGoogle Scholar
  • 89 Yang D, Du Q, Huang Z. , et al. Transcranial direct current stimulation for patients with pharmacoresistant epileptic spasms: a pilot study. Front Neurol 2019; 10: 50
    CrossrefPubMedGoogle Scholar
  • 90 Chern CR, Chern CJ, Velíšková J, Velíšek L. AQB-565 shows promise in preclinical testing in the model of epileptic spasms during infancy: head-to-head comparison with ACTH. Epilepsy Res 2019; 152: 31-34
    CrossrefPubMedGoogle Scholar
  • 91 Doumlele K, Conway E, Hedlund J, Tolete P, Devinsky O. A case report on the efficacy of vigabatrin analogue (1S, 3S)-3-amino-4-difluoromethylenyl-1-cyclopentanoic acid (CPP-115) in a patient with infantile spasms. Epilepsy Behav Case Rep 2016; 6: 67-69
    PubMedGoogle Scholar
  • 92 Scheffer IE, Berkovic S, Capovilla G. , et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58 (04) 512-521
    CrossrefPubMedGoogle Scholar