Combined Treatment for Infantile Spasms
Abstract number :
3.227
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2204949
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Diosely Silveira, MD, PhD – HMH-JFK Neuroscience Institute; Luciana de Paula Souza, MD – Universidade Federal do Parana - Brazil; Danielle Bufara, MD – Neuropediatrics – Universidade Federal do Parana - Brazil; Michelle Lucena, MD – Fellow in Neonatal-Perinatal Medicine, Pediatrics - Division of Neonatology, Children's Hospital at Montefiore; Sergio Antoniuk, MD – Universidade Federal do Parana - Brazil; Ana Chrystina Crippa, MD – Neuropediatrics – Universidade Federal do Parana - Brazil
Rationale: Infantile spasms (IS) are a severe form of epilepsy associated with multiple etiologies in the first years of life. Vigabatrin (VGB), oral corticosteroids, and adrenocorticotrophic hormone (ACTH) are the standard therapies for IS and have variable efficacy. Although treatment with a combination of drugs seems superior to monotherapy, controversies about the drug choice and medium- and long-term outcomes remain. This study aimed to evaluate the effectiveness of an outpatient protocol regarding the development of epilepsy in children who received the combined therapy.
Methods: We reviewed the data of 42 infants with IS from two neuropediatric centers treated with combined VGB and ACTH protocol between 2001 and 2021 and with an average of 4.3 years of follow-up. This study excluded those patients with tuberous sclerosis complex. This cohort analyzed retrospectively the perinatal and epilepsy history, onset of IS, treatment lag, EEG and video-EEG reports, neuroimaging, etiology, anti-seizure medications, and prospectively the development of epilepsy and progression of developmental disorders. The primary outcome was treatment efficacy set as the electroencephalographic and clinical resolution (ECR) on the seventh day of treatment and after completion of ACTH treatment. The secondary outcomes included evaluating relapses and the progression to other neurological disorders during short and medium follow-up periods.
Results: Of the 42 infants, 69% were male, 88% had symptomatic IS form, and 40.4% had other seizure types before IS. The average age of onset of IS, follow-up, and ACTH treatment lag were 6.21 months, 8.15 years, and 2.33 months, respectively. Of 42 patients started on ACTH protocol, 54.7% had ECR on the 7th day. ECR was maintained in 85.7% of patients after one month of follow-up, 73.8% after three months, and 71.4% after six months. Two patients developed an infection and had to discontinue ACTH. Relapses of IS occurred in 19.4% of patients. Resolution of spasms and hypsarrhythmia resulted in minor progression to epilepsy (p=0.006) in the medium term.
Conclusions: Our results suggest that combined treatment with VGB and ACTH effectively treats children with IS and impacts outcomes. Future research is essential to develop new protocols for the treatment of IS, including other combined medications.
Funding: No funding was secured for this study.
Clinical Epilepsy