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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
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Publication History

Publication Date:
06 March 2020 (online)

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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