Abstracts

Rationale: Infantile spasm (IS) is an epileptic syndrome in children under the age of 2 years that can have dire consequences including intellectual disability, intractable epilepsy and cerebral palsy (Trevathan et al, 1999). In addition, clinical observations and parental reports at the Infantile Epilepsy Center at Le Bonheur Children’s Hospital (LBCH) suggest a correlation between IS and dysphagia, defined as a swallowing dysfunction that requires medical or surgical intervention (Lawlor & Choi, 2020). Dysphagia affects feeding efficiency and results in failure to thrive, aspiration, and respiratory infections. However, there is a lack of published data on this association between IS and dysphagia. The aim of this study was to assess the prevalence and treatment of dysphagia in these patients.

Methods: A retrospective review was performed of subjects diagnosed with IS identified from the IS Study Database at LBCH. The following data were obtained: whether the patient was evaluated by a Speech-Language Pathologist (SLP) at the time of IS diagnosis, results of a Modified Barium Swallow (MBS) study performed in closest proximity to IS diagnosis, whether the patient was placed on thickener for dysphagia, and presence of a gastrostomy tube (GT) at any point in the patient’s clinical course.

Results: A total of 121 patients were identified between the ages of 1 and 48 months (average age at presentation, 10.4 months) with an IS diagnosis between January 2016 to May 2021. Of these, 60 patients (50%) had a bedside swallow evaluation performed by an SLP at or near the time of IS diagnosis. A total of 66 (51%) were evaluated with an MBS at any time point; 30 (25%) had an MBS within 1 week of IS diagnosis. 76 patients (63%) had a diagnosis of dysphagia at any point in their clinical course. Of those with dysphagia, 42 were placed on honey (n=24) or nectar (n=18) thickener. Forty-one patients (34%) had a GT. Nine patients (7%) were concurrently diagnosed with dysphagia and IS.

Conclusions: Patients with IS are at high risk for dysphagia with 2/3 requiring intervention and 1/3 needing a GT. A small number of patients were identified as having dysphagia at the time of the IS diagnosis—this is a time point when swallowing function should be evaluated, if it has not already been previously assessed. Screening for and treating this common comorbidity is important for preventing respiratory infection and optimizing growth and quality of life for this patient group.

References
Lawlor, C. M., & Choi, S. (2020). Diagnosis and Management of Pediatric Dysphagia: A Review. JAMA otolaryngology-- head & neck surgery, 146(2), 183–191. https://doi.org/10.1001/jamaoto.2019.3622

Trevathan, E., Murphy, C. C., & Yeargin-Allsopp, M. (1999). The descriptive epidemiology of infantile spasms among Atlanta children. Epilepsia, 40(6), 748–751. https://doi.org/10.1111/j.1528-1157.1999.tb00773.x

Funding: Please list any funding that was received in support of this abstract.: n/a.