Prioritizing Hormone Therapy over Vigabatrin as the First Treatment for Infantile Spasms - A Quality Improvement Initiative
Abstract number :
1.213
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2203945
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:22 AM
Authors :
John Mytinger, MD – Nationwide Children's Hospital, The Ohio State University; William Parker, BS, CPHQ – The Center for Clinical Excellence, Nationwide Children's Hospital; Steven Rust, Ph.D – Information Technology Research & Innovation, Nationwide Children's Hospital; Stephanie Ahrens, DO – Nationwide Children's Hospital, The Ohio State University; Dara Albert, DO – Nationwide Children's Hospital, The Ohio State University; Christopher Beatty, MD – Nationwide Children's Hospital, The Ohio State University; Julie Chrisman, BSN, RN – Nationwide Children's Hospital; Daniel Clark, MD – Nationwide Children's Hospital; Andrea Debs, MS – Nationwide Children's Hospital; Danielle Denney, HS – Nationwide Children's Hospital; Mary Karn, NP – Nationwide Children's Hospital; James Herbst, PharmD – Nationwide Children's Hospital; Adam Ostendorf, MD – Nationwide Children's Hospital, The Ohio State University; Mary Taylor, BSN, CNRN – Nationwide Children's Hospital; Jamie Twanow, MD – Nationwide Children's Hospital, The Ohio State University; Anup Patel, MD – Nationwide Children's Hospital, The Ohio State University
This abstract has been invited to present during the Pediatric Epilepsy Highlights platform session
Rationale: Infantile spasms are early childhood seizures with potentially devastating consequences. Standard therapies (adrenocorticotropic hormone [ACTH], high-dose prednisolone, and vigabatrin) are strongly recommended as the first treatment for infantile spasms. While this recommendation comes without preference for one standard therapy over another, early remission rates are higher with hormone therapy (ACTH and high-dose prednisolone) when compared to vigabatrin. Using quality improvement (QI) methodology that included hormone therapy as the first treatment, we sought to increase the percentage of children with new onset non-tuberous sclerosis complex (TSC)-associated infantile spasms achieving 3-month electroclinical remission from a mean of 53.8% to >70%.
Methods: Observational cohort study using a consecutive sample at a single academic tertiary care hospital comparing a prospective intervention cohort (May 2019 - January 2022) to a retrospective baseline cohort (November 2015 - April 2019). Our initiative addressed key drivers such as the routine use of vigabatrin over hormone therapy as first treatment and the common initiation of a second treatment after 14 days for initial non-responders. We included consecutive children without TSC presenting with new onset infantile spasms diagnosed and treated between 2 and 24 months of age. We displayed our primary outcome and process measures as control charts in which the centerline is the quarterly (previous three months) mean based on statistical process control methodology.
Results: Patient demographics are shown in the Table. This study included a consecutive sample of 124 children 2 to 24 months corrected age with new onset infantile spasms; this included 67 in the baseline cohort and 57 in the intervention cohort. The two cohorts were similar with the exception that significantly more children in the intervention cohort received hormone therapy as the first treatment (the vast majority received high-dose prednisolone), were less likely to receive vigabatrin as the first treatment, and were more likely to achieve 3-month remission. QI interventions that included the standardization of hormone therapy as the first treatment resulted in higher rates of 3-month remission, rising from a mean of 53.8% (baseline cohort) to 75.9% (intervention cohort) (Figure A). Process measure results included an increased rate of children receiving hormone therapy as first treatment (mean 44.6% to 100%, Figure B) and a decreased number of days to 1) clinical follow-up after first treatment (mean of 16.3 to 12.6 days, Figure C) and 2) starting a second treatment within 14 days for initial non-responders (mean of 36.3 to 17.2 days, Figure D).
Conclusions: For children with infantile spasms, improved rates of 3-month electroclinical remission can be achieved with QI methodology. Implementation of similar QI initiatives at other centers may likewise improve local remission rates.
Funding: None
Clinical Epilepsy