Outcomes of epileptic spasms in patients aged less than 3 years: single-center United States experience

Pediatr Neurol. 2012 May;46(5):276-80. doi: 10.1016/j.pediatrneurol.2012.02.022.

Abstract

Retrospective review was performed of children aged <3 years with epileptic spasms at our center from 2004-2010. Short-term (<6 months) and long-term (≥6 months) outcomes were assessed. We included 173 children (104 boys; median age of onset, 6.8 months) with epileptic spasms of known (62%) and unknown (38%) etiology. Treatments included adrenocorticotropic hormone (n = 103), vigabatrin (n = 82), phenobarbital (n = 34), and other agents (n = 121). Short-term treatment with adrenocorticotropic hormone and vigabatrin provided better epileptic spasm control in groups with known and unknown etiology than other agents. At follow-up (6-27 months), 54% of children manifested seizures, and 83% manifested developmental delay. Known etiology was a predictor of poor developmental outcome (P = 0.006), whereas bilateral/diffuse brain lesions predicted both poor development and seizures (P = 0.001 and 0.005, respectively). Initial presentations of epileptic spasms with hypotonia or developmental delay most strongly predicted both seizures and neurodevelopmental outcomes (P < 0.001). In a child presenting with epileptic spasms with developmental delay or hypotonia, no specific treatment may offer superior benefit.

MeSH terms

  • Adrenocorticotropic Hormone / therapeutic use
  • Anticonvulsants / therapeutic use*
  • Electroencephalography
  • Female
  • Humans
  • Infant
  • Male
  • Phenobarbital / therapeutic use
  • Retrospective Studies
  • Spasms, Infantile / drug therapy*
  • Spasms, Infantile / epidemiology*
  • Treatment Outcome
  • United States / epidemiology
  • Vigabatrin / therapeutic use

Substances

  • Anticonvulsants
  • Adrenocorticotropic Hormone
  • Vigabatrin
  • Phenobarbital