Early Treatment Response to Standard Monotherapy for Infantile Spasms
Abstract number :
2.229
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2021
Submission ID :
1826638
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Christopher Yuskaitis, MD, PhD - Boston Children's Hospital; Fiona Baumer - Stanford University School of Medicine; Sonam Bhalla - Emory University/Children’s Healthcare of Atlanta; Sonal Bhatia - Medical University of South Carolina; Shaun Hussain - UCLA Mattel Children’s Hospital; John Mytinger - Nationwide Children’s Hospital; Archana Pasupuleti - Children’s National Hospital; Debopam Samanta - University of Arkansas for Medical Sciences; Renee Shellhaas - University of Michigan; Daniel Shrey - Children’s Hospital of Orange County; Rani Singh - Atrium Health/Levine Children’s Hospital; Robert Stowe - Boston Children's Hospital; Shanshan Liu - Boston Children's Hospital; Bo Zhang - Boston Children's Hospital; Chellamani Harini - Boston Children's Hospital
Rationale: Rapid control of infantile spasms (IS) is associated with better developmental outcomes, but current practice is to wait 14 days before judging the efficacy of initial therapy. Children with refractory IS thus may benefit if treatment failure is identified earlier. We hypothesize that response to standard therapy—adrenocorticotropic hormone (ACTH), prednisolone, or vigabatrin (VGB)—occurs within the first week of treatment for the majority of IS patients.
Methods: We identified children from the National Infantile Spasms Consortium database who had received standard therapy for their initial IS treatment and who had at least one month of clinical follow-up. Exclusion criteria were lack of standard therapy, incomplete or inconsistent data, and lack of follow-up. Time to clinical spasms remission was recorded and confirmed with post-treatment EEG and clinical follow-up at 14 and 30 days following treatment initiation. Confounding variables were assessed with multivariate logistic regression. We then assessed if clinical response at day 7 predicted clinical cessation of spasms at day 14 and sustained resolution through day 30, adjusting for individual patient characteristics in multivariate logistic regression. Factors in the model were identified by univariate analysis using Fisher’s exact test for categorical variables and wilcoxon rank sum test for continuous variables with p < 0.05 for significance.
Anti-seizure Medications