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Mu C, Pochakom A, Reimer RA, Choudhary A, Wang M, Rho JM, Scantlebury MH, Shearer J. Addition of Prebiotics to the Ketogenic Diet Improves Metabolic Profile but Does Not Affect Seizures in a Rodent Model of Infantile Spasms Syndrome. Nutrients 2022; 14:2210. [PMID: 35684010 PMCID: PMC9182787 DOI: 10.3390/nu14112210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 12/04/2022] Open
Abstract
The ketogenic diet (KD) is an effective treatment for infantile spasms syndrome (IS). However, the KD has implications for somatic growth, development, and the gut microbiota. The impact of incorporating a prebiotic fiber (PRE, oligofructose-enriched inulin, 0.8 g/dL) into a KD diet on spasms, developmental milestones, fecal gut microbiota, metabolites, and hippocampal mitochondrial metabolism were examined. Following IS induction, animals were randomized to KD or KD + PRE diets. A third group without IS and suckled by dams was included as a normally developing reference group (R). PRE inclusion decreased ketones and increased circulating glucose levels but had no impact on spasms. In the liver, PRE increased triglyceride concentrations, decreased carnitine levels, and downregulated genes encoding enzymes responsible for ketogenesis. In the hippocampus, PRE increased glutathione levels but did not affect the maximal respiratory capacity of mitochondria. Analysis of the gut microbiota showed that KD + PRE increased microbial richness and the relative abundance of Bifidobacterium pseudolongum and Lactobacillus johnsonii. No differences in developmental milestones (i.e., surface righting, negative geotaxis, and open field behavior) were observed between KD and KD + PRE, except for ultrasonic vocalizations that were more frequent in KD + PRE. In summary, PRE did not impact spasms or developmental outcomes, but was effective in improving both metabolic parameters and gut microbiota diversity.
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Affiliation(s)
- Chunlong Mu
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.P.); (R.A.R.); (J.S.)
| | - Angela Pochakom
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.P.); (R.A.R.); (J.S.)
| | - Raylene A. Reimer
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.P.); (R.A.R.); (J.S.)
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.C.); (M.W.); (M.H.S.)
| | - Anamika Choudhary
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.C.); (M.W.); (M.H.S.)
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Melinda Wang
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.C.); (M.W.); (M.H.S.)
| | - Jong M. Rho
- Departments of Neurosciences, Pediatrics and Pharmacology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA;
| | - Morris H. Scantlebury
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.C.); (M.W.); (M.H.S.)
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Jane Shearer
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.P.); (R.A.R.); (J.S.)
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.C.); (M.W.); (M.H.S.)
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Craiu D, Rener Primec Z, Lagae L, Vigevano F, Trinka E, Specchio N, Bakhtadze S, Cazacu C, Golli T, Zuberi SM. Vaccination and childhood epilepsies. Eur J Paediatr Neurol 2022; 36:57-68. [PMID: 34922162 DOI: 10.1016/j.ejpn.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/08/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The evidence relating vaccination to febrile seizures and epilepsy is evaluated with an emphasis on febrile seizures (FS), Dravet syndrome (DS), West syndrome, and other developmental and epileptic encephalopathies. METHODS A systematic literature review using search words vaccination/immunization AND febrile seizures/epilepsy/Dravet/epileptic encephalopathy/developmental encephalopathy was performed. The role of vaccination as the cause/trigger/aggravation factor for FS or epilepsies and preventive measures were analyzed. RESULTS From 1428 results, 846 duplicates and 447 irrelevant articles were eliminated; 120 were analyzed. CONCLUSIONS There is no evidence that vaccinations cause epilepsy in healthy populations. Vaccinations do not cause epileptic encephalopathies but may be non-specific triggers to seizures in underlying structural or genetic etiologies. The first seizure in DS may be earlier in vaccinated versus non-vaccinated patients, but developmental outcome is similar in both groups. Children with a personal or family history of FS or epilepsy should receive all routine vaccinations. This recommendation includes DS. The known risks of the infectious diseases prevented by immunization are well established. Vaccination should be deferred in case of acute illness. Acellular pertussis DTaP (diphtheria-tetanus-pertussis) is recommended. The combination of certain vaccine types may increase the risk of febrile seizures however the public health benefit of separating immunizations has not been proven. Measles-containing vaccine should be administered at age 12-15 months. Routine prophylactic antipyretics are not indicated, as there is no evidence of decreased FS risk and they can attenuate the antibody response following vaccination. Prophylactic measures (preventive antipyretic medication) are recommended in DS due to the increased risk of prolonged seizures with fever.
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Affiliation(s)
- Dana Craiu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Department of Neurosciences, Pediatric Neurology Discipline II, Strada Dionisie Lupu No. 37, postal code: 020021, Bucharest/S2, Romania; Pediatric Neurology Clinic, Center of Expertise for Rare Disorders in Pediatric Neurology, EpiCARE member, Sos. Berceni 10, Bucharest/S4, Romania.
| | - Zvonka Rener Primec
- Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Center Ljubljana Bohoričeva 20, 1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Lieven Lagae
- University of Leuven, Department of Development and Regeneration, Section Paediatric Neurology, Herestraat 49, 3000, Leuven, Belgium.
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Piazza S. Onofrio, 4, 00151, Rome, Italy.
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Affiliated Member of the European Reference Network, EpiCARE, 5020, Salzburg, Austria; Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University Salzburg, Austria.
| | - Nicola Specchio
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Piazza S. Onofrio, 4, 00151, Rome, Italy.
| | - Sophia Bakhtadze
- Department of Paediatric Neurology, Tbilisi State Medical University, 0160, Tbilisi, Georgia.
| | - Cristina Cazacu
- Pediatric Neurology Clinic, Center of Expertise for Rare Disorders in Pediatric Neurology, EpiCARE member, Sos. Berceni 10, Bucharest/S4, Romania.
| | - Tanja Golli
- Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Center Ljubljana Bohoričeva 20, 1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Sameer M Zuberi
- Paediatric Neurosciences, Royal Hospital for Children, Glasgow, UK; Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
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Weingarten MM, Cokley JA, Moffett B, DiCarlo S, Misra SN. Trends and Costs Associated With the Diagnosis and Treatment of Infantile Spasms: A 10-Year Multicenter Retrospective Review. J Pediatr Pharmacol Ther 2021; 27:29-37. [PMID: 35002556 PMCID: PMC8717615 DOI: 10.5863/1551-6776-27.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Early treatment of infantile spasms (IS) may be imperative for improvement of neurodevelopmental outcomes. Existing studies have led to inconclusive recommendations with variation in treatment. Our objective was to determine the national average cost, initial diagnostic workup, treatments, and hospital length of stay for patients with IS. METHODS This retrospective cohort study was designed to review data of patients < 2 years from 43 non-profit institutions. Data obtained included patient demographics, length of stay, admission cost, and treatments used from 2004 to 2014. Cost data were collected and adjusted to 2014 dollars, the year data were analyzed. RESULTS A total of 6183 patients met study criteria (n = 3382, 55% male). Three-quarters of patients (n = 4684, 76%) had an electroencephalogram, 56.4% had brain imaging (n = 3487), and 17% (n = 1050) underwent a lumbar puncture. Medication for IS was initiated during inpatient hospital stay in two-thirds of all patients (n = 4139, 67%). Most patients were initiated on corticotropin (n = 2066, 33%) or topiramate (n = 1804, 29%). Average length of stay was 5.8 days with an average adjusted cost of $18,348. Over time there was an 86.6% increase in cost from an average $12,534.54 (2004) to $23,391.20 (2014), a significant change (p < 0.01). This correlated with an increase in average length of stay. CONCLUSIONS Variability exists in diagnostic workup and pharmacotherapy initiated for IS, which may lead to differences in the cost of hospital stay. Further studies may help determine contributing factors to increased cost and improve health care utilization for IS patients.
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Affiliation(s)
| | - Jon A. Cokley
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX (JAC, BM, SD)
| | - Brady Moffett
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX (JAC, BM, SD)
| | - Shannon DiCarlo
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX (JAC, BM, SD)
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Grinspan ZM, Mytinger JR, Baumer FM, Ciliberto MA, Cohen BH, Dlugos DJ, Harini C, Hussain SA, Joshi SM, Keator CG, Knupp KG, McGoldrick PE, Nickels KC, Park JT, Pasupuleti A, Patel AD, Shahid AM, Shellhaas RA, Shrey DW, Singh RK, Wolf SM, Yozawitz EG, Yuskaitis CJ, Waugh JL, Pearl PL. Management of Infantile Spasms During the COVID-19 Pandemic. J Child Neurol 2020; 35:828-834. [PMID: 32576057 PMCID: PMC7315378 DOI: 10.1177/0883073820933739] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Circumstances of the COVID-19 pandemic have mandated a change to standard management of infantile spasms. On April 6, 2020, the Child Neurology Society issued an online statement of immediate recommendations to streamline diagnosis and treatment of infantile spasms with utilization of telemedicine, outpatient studies, and selection of first-line oral therapies as initial treatment. The rationale for the recommendations and specific guidance including follow-up assessment are provided in this manuscript. These recommendations are indicated as enduring if intended to outlast the pandemic, and limited if intended only for the pandemic health care crisis but may be applicable to future disruptions of health care delivery.
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Affiliation(s)
| | | | | | | | - Bruce H. Cohen
- Children’s Hospital Medical Center of Akron, Akron, OH, USA
| | | | - Chellamani Harini
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Shaun A. Hussain
- University of California Los Angeles Mattel Children’s Hospital, Los Angeles, CA, USA
| | | | | | | | | | | | - Jun T. Park
- University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH, USA
| | | | | | - Asim M. Shahid
- University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH, USA
| | | | | | - Rani K. Singh
- Levine Children’s Hospital at Atrium Health System, Charlotte, NC, USA
| | | | | | | | - Jeff L. Waugh
- University of Texas Southwestern Medical Center Southwestern, Dallas, TX, USA
| | - Phillip L. Pearl
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA,Phillip L. Pearl, MD, Department of Neurology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, USA.
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Quilião ME, Venancio FA, Mareto LK, Metzker SDA, do Nascimento AI, Vitorelli-Venancio DC, Santos-Pinto CDB, de Oliveira EF. Neurological Development, Epilepsy, and the Pharmacotherapy Approach in Children with Congenital Zika Syndrome: Results from a Two-Year Follow-up Study. Viruses 2020; 12:v12101083. [PMID: 32992985 PMCID: PMC7601787 DOI: 10.3390/v12101083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/19/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
Clinical outcomes related to congenital Zika syndrome (CZS) include microcephaly accompanied by specific brain injuries. Among several CZS outcomes that have been described, epilepsy and motor impairments are present in most cases. Pharmacological treatment for seizures resulting from epilepsy is performed with anticonvulsant drugs, which in the long term are related to impairments in the child's neuropsychomotor development. Here, we describe the results from a two-year follow-up of a cohort of children diagnosed with CZS related to the growth of the head circumference and some neurological and motor outcomes, including the pharmacological approach, and its results in the treatment of epileptic seizures. This paper is part of a prospective cohort study carried out in the state of Mato Grosso Sul, Brazil, based on a Zika virus (ZIKV)-exposed child population. Our data were focused on the assessment of head circumference growth and some neurological and motor findings, including the description of seizure conditions and pharmacological management in two periods. Among the 11 children evaluated, 8 had severe microcephaly associated with motor impairment and/or epilepsy. Seven children were diagnosed with epilepsy. Of these, 3 had West syndrome. In four children with other forms of epilepsy, there was no pharmacological control.
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Affiliation(s)
- Maria Eulina Quilião
- Centro Especializado em Reabilitação, Associação de Pais e Amigos dos Excepcionais, Campo Grande 79050-140, Brazil;
| | - Fabio Antonio Venancio
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (F.A.V.); (D.C.V.-V.)
| | - Lisany Krug Mareto
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (L.K.M.); (C.D.B.S.-P.)
| | - Sahra de Almeida Metzker
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Ana Isabel do Nascimento
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Daniele Cristina Vitorelli-Venancio
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (F.A.V.); (D.C.V.-V.)
| | - Cláudia Du Bocage Santos-Pinto
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (L.K.M.); (C.D.B.S.-P.)
| | - Everton Falcão de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (F.A.V.); (D.C.V.-V.)
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (L.K.M.); (C.D.B.S.-P.)
- Correspondence: ; Tel.: +55-67-3345-7403
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Vigabatrin-Induced Encephalopathy in a 5.5-Month-Old Girl with Infantile Spasms due to Tuberous Sclerosis. Case Rep Pediatr 2019; 2019:7249237. [PMID: 31534811 PMCID: PMC6732644 DOI: 10.1155/2019/7249237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 12/29/2022] Open
Abstract
A 5.5-month-old female infant with tuberous sclerosis complex presented with infantile spasms and was treated with vigabatrin. As her condition did not improve, she was given adrenocorticotropic hormone (ACTH) intramuscularly which stopped the spasms and improved the electroencephalogram (EEG) abnormalities. However, she developed encephalopathy with apathy, drowsiness, and generalized slowing in the EEG. Discontinuation of vigabatrin quickly improved her symptoms and reversed the EEG slowing. A high index of suspicion is required in order to diagnose vigabatrin-induced encephalopathy, especially as the underlying disorders of these patients can be erroneously considered the cause of the observed encephalopathy.
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Barba C, Mai R, Grisotto L, Gozzo F, Pellacani S, Tassi L, Francione S, Giordano F, Cardinale F, Guerrini R. Unilobar surgery for symptomatic epileptic spasms. Ann Clin Transl Neurol 2016; 4:36-45. [PMID: 28078313 PMCID: PMC5221449 DOI: 10.1002/acn3.373] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To assess factors associated with favorable seizure outcome after surgery for symptomatic epileptic spasms and improve knowledge on pathophysiology of this seizure type. Methods Inclusion criteria were: (1) age between 6 months and 15 years at surgery; (2) active epileptic spasms; (3) follow‐up after surgery >1 year. Results We retrospectively studied 80 children (aged 1.3 ± 2 years at seizure onset; 5.8 ± 4 years at surgery, 11.7 ± 5.7 years at last follow up). Magnetic resonance imaging (MRI) revealed structural abnormalities in 77/80 patients (96.3%; unilateral in 69: 89.6%). We performed invasive recordings in 24 patients (30%). In 21 patients in whom MRI or histopathology detected a lesion, electrodes exploring it constantly captured initial ictal activity at spasm onset. Fifty‐eight patients (72.5%) underwent unilobar and 22 (27.5%) multilobar or hemispheric procedures. At last follow‐up, 49 patients (61.3%) were in Engel class I. Multivariate logistic models showed completeness of resection of the seizure onset zone (OR = 0.016, 95%CI: 0.002, 0.122) and of the MRI visible lesion (OR = 0.179, 95% CI: 0.032, 0.999) to be significantly associated with Engel class IA outcome. Unfavorable outcome was associated with an older age at surgery, when it reflected a longer duration of epilepsy (OR = 1.383, 95% CI: 0.994,1.926). Interpretation Data emerging from invasive recordings and the good seizure outcome following removal of discrete epileptogenic lesions support a focal cortical origin of spasms. In patients with discrete epileptogenic lesions, the pragmatic approach to surgery should follow the same principles applied to focal epilepsy favoring, whenever possible, unilobar, one‐stage resections.
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Affiliation(s)
- Carmen Barba
- Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy
| | - Roberto Mai
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy
| | - Laura Grisotto
- Department of Statistics, Computer Science, Applications "G. Parenti" University of Florence Florence Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy
| | - Simona Pellacani
- Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy; IRCCS Stella Maris Pisa Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy
| | - Stefano Francione
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy
| | - Flavio Giordano
- Neurosurgery Department Children's Hospital Anna Meyer-University of Florence Florence Italy
| | | | - Renzo Guerrini
- Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy; IRCCS Stella Maris Pisa Italy
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Current understanding and neurobiology of epileptic encephalopathies. Neurobiol Dis 2016; 92:72-89. [DOI: 10.1016/j.nbd.2016.03.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 12/25/2022] Open
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Brain MRI findings with vigabatrin therapy: case report and literature review. Clin Imaging 2015; 40:180-2. [PMID: 26526789 DOI: 10.1016/j.clinimag.2015.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 11/23/2022]
Abstract
Infantile spasm or West syndrome is a pediatric epileptic disorder characterized by flexor and/or extensor spasms beginning in childhood. Vigabatrin is an effective medical therapy for infantile spasm but has pronounced, potentially worrisome imaging findings in patients receiving therapy. We present the case of an 8-month-old infant with such brain magnetic resonance imaging findings after treatment initiation. In this article, we highlight the imaging changes and discuss the differential diagnosis along with the required follow-up.
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Relationship between initial electroencephalographic characteristics and seizure outcomes in children with non-lesional West syndrome. Epilepsy Res 2015; 110:49-54. [PMID: 25616455 DOI: 10.1016/j.eplepsyres.2014.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/16/2014] [Accepted: 11/19/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND To characterize the initial interictal electroencephalography (EEG) activities associated with seizure outcomes in children with non-lesional West syndrome (WS), and their worth in the prediction of seizure-free (SF) vs no seizure-free (No-SF) outcomes. METHODS We retrospectively reviewed the initial scalp EEGs for at least a 40-min duration, and the medical records of 66 children who were diagnosed as WS with normal MRI, and who were followed-up with for 4.5 ± 2.1 years. We assessed the following clinical and EEG findings: onset of seizures, development, underlying etiologies, initial interictal EEGs, and seizure evolution. These variables were compared between two groups: SF vs No-SF groups. RESULTS In total, 36 (54.5%) children had SF outcomes and 30 (45.5%) had No-SF outcomes during long-term follow-up (4.4 ± 2.3 vs 4.6 ± 2.0 years, p = 0.7644). The mean age at seizure onset was similar in the SF and No-SF groups (6.0 ± 3.0 vs 6.9 ± 3.2 months, p = 0.2443). Delayed development before the onset of spasms was similarly observed in both groups (13.9% vs 13.3%). Initial EEG findings significantly differed with typical hypsarrhythmia (41.7% vs 73.3%, p = 0.0098), multiple independent spike foci (MISF) (55.6% vs 83.3%, p = 0.0158), frontal-dominant MISF (0.0% vs 40.0%, p < 0.0001), and frontal-dominant generalized epileptiform discharges (EDs) (0.0% vs 16.7%, p=0.0108) being involved more infrequently in the SF group than in the No-SF group, respectively. Patients in the SF group showed no frontal-dominant MISF or frontal-dominant generalized EDs, and a more often normal to borderline sleep-spindle (83.3% vs 40.0%, p = 0.0002) than the No-SF group. CONCLUSION Patients with SF outcomes more frequently showed the posterior-dominant generalized EDs and normal to borderline sleep-spindle, and the No-SF group more often had typical hypsarrhythmia, frontal-dominant MISF, frontal-dominant generalized EDs, and no normal sleep-spindle. Initial interictal EEG findings may predict seizure outcomes in patients with non-lesional WS.
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Inoue T, Shimizu M, Hamano SI, Murakami N, Nagai T, Sakuta R. Epilepsy and West syndrome in neonates with hypoxic-ischemic encephalopathy. Pediatr Int 2014; 56:369-72. [PMID: 24274080 DOI: 10.1111/ped.12257] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/30/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Perinatal hypoxic-ischemic encephalopathy (HIE) has been linked to the development of late-onset seizures. The aim of the present study was to determine the incidence of epilepsy and West syndrome in children with perinatal HIE and identify factors associated with the development of postnatal seizure disorders. METHODS We retrospectively enrolled 208 term and late-preterm infants diagnosed with perinatal HIE from April 2000 to March 2009 at Saitama Children's Medical Center. Children with obvious multiple anomalies and known chromosomal abnormalities were excluded. A questionnaire was distributed to parents to determine seizure-related outcomes. Medical records were retrospectively reviewed and relevant clinical parameters were analyzed. RESULTS In total, 162 questionnaires were answered (77.9%). Of the 162 subjects, 26 (16.0%) developed epilepsy, and eight subjects (4.9%) were diagnosed with West syndrome. Neonatal seizures occurred in 72 subjects (44.4%). The incidence of epilepsy and West syndrome was significantly higher in infants who experienced neonatal seizures than in those without seizure history. A total of 82 subjects were diagnosed with moderate (n = 52) or severe HIE (n = 30), of whom 57 subjects (69.5%) received therapeutic hypothermia. The incidence of epilepsy was significantly lower in these treated subjects. In addition, subjects with moderate or severe HIE were significantly more likely to develop late-onset epilepsy and West syndrome than those with mild HIE. CONCLUSIONS The severity of perinatal HIE and neonatal seizures is a potential risk factor for the development of late-onset seizures. Therapeutic hypothermia may reduce the risk of the development of epilepsy in such cases.
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Affiliation(s)
- Takeshi Inoue
- Department of Pediatrics, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan; Division of Neonatology, Saitama Children's Medical Center, Saitama, Japan
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Kaushik JS, Patra B, Sharma S, Yadav D, Aneja S. Clinical spectrum and treatment outcome of West Syndrome in children from Northern India. Seizure 2013; 22:617-21. [DOI: 10.1016/j.seizure.2013.04.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/12/2013] [Accepted: 04/14/2013] [Indexed: 10/26/2022] Open
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Lee J, Lee JH, Yu HJ, Lee M. Prognostic factors of infantile spasms: role of treatment options including a ketogenic diet. Brain Dev 2013; 35:821-6. [PMID: 23856457 DOI: 10.1016/j.braindev.2013.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 05/20/2013] [Accepted: 06/21/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to provide additional evidences on prognostic factors for infantile spasms and the possible role of a ketogenic diet. METHODS A retrospective analysis was performed for patients with infantile spasms who had been followed up for more than 6months between January 2000 and July 2012 at Samsung Medical Center (Seoul, Republic of Korea). We analyzed the association between possible prognostic factors and seizure/developmental outcomes. RESULTS Sixty-nine patients were included in this study and their mean follow-up duration was 52.5 (9-147) months. In the patients who had been followed up for more than 2years, 53.6% (n=30/57) remained seizure-free at the last visit. Sixty patients (86.9%) showed developmental delay at last follow-up. Forty-two patients (60.9%) became spasm-free with one or two antiepileptic drugs, one patient with epilepsy surgery for a tumor, and seven patients with a ketogenic diet after the failure of two or more antiepileptic drugs. The etiology and age of seizure onset were the significant prognostic factors. CONCLUSIONS In this study, about 60% of the patients became spasm-free with vigabatrin and topiramate. Ketogenic diet increased the rate by 10% in the remaining antiepileptic drug resistant patients. However, 86.9% of the patients showed developmental delay, mostly a severe degree. Early diagnosis and prompt application of treatment options such as antiepileptic drugs, a ketogenic diet or epilepsy surgery can improve outcomes in patients with infantile spasms.
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Affiliation(s)
- Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Mure T, Nakagawa T, Okizuka Y, Takami Y, Oyazato Y, Nagase H, Maruyama A, Adachi M, Takada S, Matsuo M. Treatment of preterm infants with West syndrome: differences due to etiology. Pediatr Int 2012; 54:892-8. [PMID: 22882769 DOI: 10.1111/j.1442-200x.2012.03708.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 05/28/2012] [Accepted: 08/02/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted with a particular focus on preterm infants with West syndrome (WS) to evaluate differences in the first responses to oral medication based on etiology. METHODS Medical records of 53 patients with WS, treated at five institutions between 2005 and 2009, were reviewed retrospectively. Patients were divided into six groups based on the time of brain insult, and evaluated for short-term outcomes using oral anti-epileptic agents and synthetic adrenocorticotropic hormone. RESULTS The sample consisted of 15, six, 14, two, four, and 12 patients classified, on the basis of apparent time of acquisition of etiology, into the prenatal, term, preterm, postnatal, other, and no identified etiology groups, respectively. Average age of onset in the term group was 3.3 ± 1.0 months, significantly earlier than in the prenatal, preterm, postnatal and no identified etiology groups (P < 0.05). All patients in the term group had experienced seizures before the onset of WS. Only patients in the preterm group had only experienced neonatal seizures, and responded better to treatment. Patients in the preterm group had better responses to treatment, especially oral medication, compared with those in the prenatal and term groups. The prevalence of relapse of seizures in the preterm group (14%) was significantly lower than that in the prenatal group. CONCLUSIONS Preterm WS patients responded well to treatment. Distinguishing WS patients on the basis of different etiologies is important for evaluating the effectiveness of treatment.
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Affiliation(s)
- Takeo Mure
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
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15
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Diagnosis delay in West syndrome: misdiagnosis and consequences. Eur J Pediatr 2012; 171:1695-701. [PMID: 22892960 DOI: 10.1007/s00431-012-1813-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 07/31/2012] [Indexed: 10/28/2022]
Abstract
West syndrome or infantile spasms is one of the most frequent epileptic syndromes in the first year of life. The clinical symptoms of infantile spasms are very different than any other type of seizure because of both the absence of paroxysmal motor phenomena (i.e., as in a convulsion) and the lack of significant duration of loss of consciousness (i.e., as in absence epilepsy). Infantile spasms may lead to misdiagnosis by pediatricians and other primary care providers. We assessed the missed diagnoses prior to the diagnosis of infantile spasms. We hypothesized that a delay in treatment may have consequences on neurologic outcome. We conducted a multicenter, retrospective, observational study to evaluate occurrence of misdiagnosis and its possible consequences. We performed a multivariate analysis to evaluate the risk for the outcome 2 years after the diagnosis of infantile spasms. We included 83 infants over a 5-year period. The majority of consulted physicians (301 of 362) did not suggest any specific diagnosis while the others suggested gastroesophageal reflux (7 %), constipation (7 %), or colitis (3 %). Results indicated that a poor outcome was related to a delay in diagnosis, which was observed regardless of the existence of cognitive involvement prior to the start of infantile spasms (Relative Risk: RR 12.08 [1.52-96.3]). These results highlight the importance of making an early diagnosis of infantile spasms.
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Gkampeta A, Pavlou E. Infantile spasms (West syndrome) in children with inborn errors of metabolism: a review of the literature. J Child Neurol 2012; 27:1295-301. [PMID: 22832779 DOI: 10.1177/0883073812448532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
West syndrome (infantile spasms) is an epileptic encephalopathy that includes psychomotor deterioration. In rare cases, it is due to an inherited, progressive metabolic disease. More than 25 inborn errors of metabolism have been considered etiologic or predisposing factors for infantile spasms. This is a review of the literature on reported cases of children diagnosed with a metabolic disease who developed infantile spasms. This article presents in brief the most frequent inborn errors of metabolism that have been associated with West syndrome and also illustrates the importance of screening for inborn errors of metabolism in infantile spasms.
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Affiliation(s)
- Anastasia Gkampeta
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece.
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17
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Ramgopal S, Shah A, Zarowski M, Vendrame M, Gregas M, Alexopoulos AV, Loddenkemper T, Kothare SV. Diurnal and sleep/wake patterns of epileptic spasms in different age groups. Epilepsia 2012; 53:1170-7. [DOI: 10.1111/j.1528-1167.2012.03499.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
When mimicking epileptic processes in a laboratory setting, it is important to understand the differences between experimental models of seizures and epilepsy. Because human epilepsy is defined by the appearance of multiple spontaneous recurrent seizures, the induction of a single acute seizure without recurrence does not constitute an adequate epilepsy model. Animal models of epilepsy might be useful for various tasks. They allow for the investigation of pathophysiological mechanisms of the disease, the evaluation, or the development of new antiepileptic treatments, and the study of the consequences of recurrent seizures and neurological and psychiatric comorbidities. Although clinical relevance is always an issue, the development of models of pediatric epilepsies is particularly challenging due to the existence of several key differences in the dynamics of human and rodent brain maturation. Another important consideration in modeling pediatric epilepsy is that "children are not little adults," and therefore a mere application of models of adult epilepsies to the immature specimens is irrelevant. Herein, we review the models of pediatric epilepsy. First, we illustrate the differences between models of pediatric epilepsy and models of the adulthood consequences of a precipitating insult in early life. Next, we focus on new animal models of specific forms of epilepsies that occur in the developing brain. We conclude by emphasizing the deficiencies in the existing animal models and the need for several new models.
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Alshami R, Bessisso M, El Said M, Venktraman B. Neuro-lmages of Patients with Infantile Spasm. Qatar Med J 2011. [DOI: 10.5339/qmj.2011.2.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
With the intention of assessing the neuro-imaging, clarifying the percentages of symptomatic, idiopathic and cryptogenic cases and identifying the underlying causes, records were reviewed retrospectively of 30 children with infantile spasm admitted to Hamad Medical Corporation, Doha, Qatar. Twenty-three patients were symptomatic, four idiopathic and three cryptogenic. Brain CT and MRI scans of 13 cases detected similar neuro-imaging findings in nine cases while MRI provided more information in another four cases. Three patients had normal neuro-images despite persistently abnormal EEGs. We conclude that MRI scans are superior to CT scans in detecting areas of cortical dysgenesis, disorders of neuronal migration, or disorders of myelination although more advanced studies are required for patients with persistently abnormal EEGs but normal MRIs.
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Affiliation(s)
- R. Alshami
- Pediatric Neurology Section, Department of Pediatrics, Doha, Qatar
| | - M. Bessisso
- Pediatric Neurology Section, Department of Pediatrics, Doha, Qatar
| | - M.F. El Said
- Pediatric Neurology Section, Department of Pediatrics, Doha, Qatar
| | - B. Venktraman
- **Radiology Department, Hamad Medical Corporation, Doha, Qatar
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20
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von Spiczak S, Helbig I, Drechsel-Baeuerle U, Muhle H, van Baalen A, van Kempen MJ, Lindhout D, Scheffer IE, Berkovic SF, Stephani U, Keller-Stanislawski B. A retrospective population-based study on seizures related to childhood vaccination. Epilepsia 2011; 52:1506-12. [DOI: 10.1111/j.1528-1167.2011.03134.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Specchio N, Trivisano M, Vigevano F, Fusco L. Idiopathic West Syndrome followed by childhood absence epilepsy. Seizure 2010; 19:597-601. [DOI: 10.1016/j.seizure.2010.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 07/23/2010] [Accepted: 07/30/2010] [Indexed: 11/28/2022] Open
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22
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Kato T, Okumura A, Hayakawa F, Tsuji T, Hayashi S, Kubota T, Fukasawa T, Suzuki M, Maruyama K, Oshiro M, Hattori T, Kidokoro H, Natsume J, Hayakawa M, Watanabe K. Prolonged EEG depression in term and near-term infants with hypoxic ischemic encephalopathy and later development of West syndrome. Epilepsia 2010; 51:2392-6. [PMID: 20887363 DOI: 10.1111/j.1528-1167.2010.02727.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was performed to clarify the relationship between prolonged depression of electroencephalography (EEG) in term and near-term infants with hypoxic ischemic encephalopathy (HIE) and the later development of West syndrome (WS). METHODS We investigated 17 term and near-term infants with HIE. Inclusion criteria were as follows: ≥35 weeks of gestation, clinical signs of HIE, magnetic resonance imaging (MRI) lesions corresponding to HIE, assessment of outcome at >18 months of age, depression of EEG, and serial EEG examinations. The 17 infants were divided into the following two groups: Group A (n = 4) with prolonged EEG depression over 21 days of age, and group B (n = 13) with disappearance of EEG depression by 21 days of age. RESULTS WS developed in all four infants in group A, but in only one of 13 infants in group B. WS occurred significantly more frequently in group A than in group B. For the prediction of subsequent development of WS, prolonged EEG depression over 21 days of age showed sensitivity of 0.80 and specificity of 1.0. In both groups, abnormal irregular faster waves with or without EEG depression were seen in 11 infants between 2 and 28 days of age. They had no significant relationship with WS, but were significantly related to an adverse developmental outcome. CONCLUSIONS Prolonged depression of EEG over 21 days of age in term or near-term infants with HIE is a valuable predictor of the later development of WS.
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Affiliation(s)
- Toru Kato
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Aichi, Japan.
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Perret EV, von Elm E, Lienert C, Steinlin M. Infantile spasms: does season influence onset and long-term outcome? Pediatr Neurol 2010; 43:92-6. [PMID: 20610118 DOI: 10.1016/j.pediatrneurol.2010.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/08/2010] [Indexed: 11/15/2022]
Abstract
To study whether onset of infantile spasms manifests seasonal variation, as previously reported, and whether any such seasonality is associated with treatment response and long-term outcome, data for 57 patients were retrospectively reviewed. The data were collected from hospital files and through a mail survey of children with infantile spasms born from 1980 to 2002 and monitored at the University Children's Hospital of Berne, Switzerland. The mean age at time of onset of infantile spasms was 7 months (range, 0.75-40), at diagnosis 8 months (range, 1-42) and at follow-up 11.3 years (range, 1-23 years). In 77% of participants, the etiology of infantile spasms was known (symptomatic); in the remaining 23% it was not known (nonsymptomatic). In contrast to previous findings, onset of infantile spasms was not associated with calendar month, photoperiod, or global solar radiation. Long-term prognosis was poor: 4 of the 57 (7%) children died; 49 (86%) had cognitive impairment and 40 (70%) had physical impairment; 31 (54%) had cerebral palsy, 37 had (65%) persistent seizures, and 9 (16%) had Lennox-Gastaut syndrome. Symptomatic infantile spasms were associated with worse cognitive outcome (P < 0.001), but treatment modality and overall duration of infantile spasms were not. There was no association of calendar month or photoperiod at onset with cognitive outcome or treatment response.
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Affiliation(s)
- Eveline V Perret
- Division of Pediatric Neurology, Children's University Hospital, Inselspital, 3010 Berne, Switzerland
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24
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Scantlebury MH, Galanopoulou AS, Chudomelova L, Raffo E, Betancourth D, Moshé SL. A model of symptomatic infantile spasms syndrome. Neurobiol Dis 2009; 37:604-12. [PMID: 19945533 DOI: 10.1016/j.nbd.2009.11.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 10/27/2009] [Accepted: 11/13/2009] [Indexed: 11/16/2022] Open
Abstract
Infantile spasms are characterized by age-specific expression of epileptic spasms and hypsarrhythmia and often result in significant cognitive impairment. Other epilepsies or autism often ensue especially in symptomatic IS (SIS). Cortical or subcortical damage, including white matter, have been implicated in the pathogenesis of SIS. To generate a model of SIS, we recreated this pathology by injecting rats with lipopolysaccharide and doxorubicin intracerebrally at postnatal day (P) 3 and with p-chlorophenylalanine intraperitoneally at P5. Spasms occurred between P4 and 13 and were associated with ictal EEG correlates, interictal EEG abnormalities and neurodevelopmental decline. After P9 other seizures, deficits in learning and memory, and autistic-like behaviors (indifference to other rats, increased grooming) were observed. Adrenocorticotropic hormone (ACTH) did not affect spasms. Vigabatrin transiently suppressed spasms at P5. This new model of SIS will be useful to study the neurobiology and treatment of SIS, including those that are refractory to ACTH.
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Affiliation(s)
- Morris H Scantlebury
- Saul R. Korey Department of Neurology, Laboratory of Developmental Neurology, and Montefiore/Einstein Epilepsy Management Center, USA.
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25
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Hur YJ, Lee JS, Kang HC, Park HJ, Yun MJ, Kim HD. Ictal single-photon emission computed tomography with slow dye injection for determining primary epileptic foci in infantile spasms. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.7.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yun Jung Hur
- Department of Pediatrics, Pochon Cha University College of Medicine, Korea
| | - Joon Soo Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Handicapped Children's Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon Chul Kang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Handicapped Children's Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jung Park
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jin Yun
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Handicapped Children's Institute, Yonsei University College of Medicine, Seoul, Korea
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26
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Mayor-Dubois C, Maeder-Ingvar M, Deonna T, Roulet-Perez E. The role of epilepsy in early language development in a child with a congenital lesion in the right hemisphere. Dev Med Child Neurol 2008; 50:870-5. [PMID: 19046180 DOI: 10.1111/j.1469-8749.2008.03162.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early epilepsy is known to worsen the developmental prognosis of young children with a congenital focal brain lesion, but its direct role is often very difficult to delineate from the other variables. This requires prolonged periods of follow-up with simultaneous serial electrophysiological and developmental assessments which are rarely obtained. We studied a male infant with a right prenatal infarct in the territory of the right middle cerebral artery resulting in a left spastic hemiparesis, and an epileptic disorder (infantile spasms with transient right hemihypsarrhythmia and focal seizures) from the age of 7 months until the age of 4 years. Pregnancy and delivery were normal. A dissociated delay of early language acquisition affecting mainly comprehension without any autistic features was documented. This delay was much more severe than usually expected in children with early focal lesions, and its evolution, with catch-up to normal, was correlated with the active phase of the epilepsy. We postulate that the epilepsy specifically amplified a pattern of delayed language emergence, mainly affecting lexical comprehension, reported in children with early right hemisphere damage.
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Affiliation(s)
- C Mayor-Dubois
- Department of Pediatrics, Centre Hospitalier Vaudois, 1011 Lausanne, Switzerland
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27
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Hayashi M, Itoh M, Araki S, Kumada S, Tanuma N, Kohji T, Kohyama J, Iwakawa Y, Satoh J, Morimatsu Y. Immunohistochemical analysis of brainstem lesions in infantile spasms. Neuropathology 2008. [DOI: 10.1111/j.1440-1789.2000.00353.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Masaharu Hayashi
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience and
| | - Masahiro Itoh
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience and
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Araki
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience and
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoko Kumada
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience and
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Tanuma
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience and
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshihiko Kohji
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience and
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Kohyama
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihide Iwakawa
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Satoh
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience and
| | - Yoshio Morimatsu
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience and
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Takano T, Hayashi A, Sokoda T, Sawai C, Sakaue Y, Takeuchi Y. Delayed myelination at the onset of cryptogenic West syndrome. Pediatr Neurol 2007; 37:417-20. [PMID: 18021923 DOI: 10.1016/j.pediatrneurol.2007.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 06/07/2007] [Accepted: 06/27/2007] [Indexed: 10/22/2022]
Abstract
To evaluate the prognostic value of delayed myelination at the onset of cryptogenic West syndrome, the relationship between the seizure or developmental outcome and myelination was examined. Cranial magnetic resonance imaging studies were performed in nine cryptogenic cases. Infantile spasms were controlled in all patients, but three cases showed a mild developmental delay at 2 years after onset. Delayed myelination was observed in three cases (33.3%) on T(1)-weighted images and in two cases (22.2%) on T(2)-weighted images. In the present study, neither the seizure outcome nor developmental status was positively correlated with the existence of delayed myelination at the onset of cryptogenic West syndrome.
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Affiliation(s)
- Tomoyuki Takano
- Department of Pediatrics, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Japan.
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Endoh F, Yoshinaga H, Kobayashi K, Ohtsuka Y. Electroencephalographic changes before the onset of symptomatic West syndrome. Brain Dev 2007; 29:630-8. [PMID: 17555900 DOI: 10.1016/j.braindev.2007.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 03/23/2007] [Accepted: 04/18/2007] [Indexed: 11/28/2022]
Abstract
To clarify the characteristics of the mode of appearance and morphology of epileptiform discharges before the onset of West syndrome (WS). The subjects were 25 infants whose electroencephalograms (EEGs) were recorded before the onset of WS and whose first EEG was recorded before 6 months of corrected age (CA). We extensively analyzed the chronological and topographical changes of the epileptiform discharges before the onset of WS. The location of the initial epileptiform discharges was in the posterior areas in 14 (Group O), the multiple areas in 7 (Group M), and areas other than occipital in 4 (Group non-O). Twelve of the 14 patients in Group O were premature infants, and all but one had PVL. Most patients in Group M were full-term infants or near full-term infants who had hypoxic damage. The ages at the appearance of the initial epileptiform discharges in Group O were significantly later than those in Group M: 3.0-5.9 months of CA in Group O vs. -0.1 to 2.0 months of CA in Group M. These facts suggest that the difference of brain damage is related to both the topographical characteristics and the age at the appearance of initial epileptiform discharges, and around 3 months of CA is a critical period for the appearance of occipital hyperexcitability. Hypsarrhythmia and tonic spasms appeared almost simultaneously from 4 to 6 months of CA in most patients. To predict the occurrence of WS in high-risk infants, EEG follow-ups from early infancy are very useful.
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Affiliation(s)
- Fumika Endoh
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
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Bahi-Buisson N, Eisermann M, Nivot S, Bellanné-Chantelot C, Dulac O, Bach N, Plouin P, Chiron C, de Lonlay P. Infantile spasms as an epileptic feature of DEND syndrome associated with an activating mutation in the potassium adenosine triphosphate (ATP) channel, Kir6.2. J Child Neurol 2007; 22:1147-50. [PMID: 17890419 DOI: 10.1177/0883073807306272] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Activating mutations in the Kir6.2 subunit of the adenosine triphosphate-sensitive potassium (KATP) channel is a cause of neonatal diabetes associated with various neurological disorders that include developmental delay, epilepsy, and neonatal diabetes (known together as DEND syndrome). This article reports a girl who developed infantile spasms and early onset diabetes mellitus at the age of 3 months and revealed DEND syndrome with a heterozygous activating mutation in Kir6.2. Infantile spasms with hypsarrhythmia on the electroencephalogram were severe and refractory to steroids. Steroids combined with oral sulfonylurea, a drug that closes the ATP-sensitive potassium channel by an independent mechanism, allowed partial and transitory control of the epilepsy. However, the child still exhibited severe encephalopathy and died of aspiration pneumonia. The role of oral sulfonylurea as an anticonvulsant in DEND syndrome associated with Kir6.2 mutation is discussed.
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MESH Headings
- Anticonvulsants/therapeutic use
- Brain Chemistry/genetics
- Brain Diseases, Metabolic/genetics
- Brain Diseases, Metabolic/metabolism
- Brain Diseases, Metabolic/physiopathology
- DNA Mutational Analysis
- Developmental Disabilities/genetics
- Developmental Disabilities/metabolism
- Developmental Disabilities/physiopathology
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/physiopathology
- Electroencephalography
- Epilepsy/genetics
- Epilepsy/metabolism
- Epilepsy/physiopathology
- Fatal Outcome
- Female
- Genetic Predisposition to Disease/genetics
- Humans
- Hypoglycemic Agents/therapeutic use
- Infant
- Mutation/genetics
- Pneumonia, Aspiration/etiology
- Potassium Channel Blockers/therapeutic use
- Potassium Channels, Inwardly Rectifying/genetics
- Spasms, Infantile/genetics
- Spasms, Infantile/metabolism
- Spasms, Infantile/physiopathology
- Steroids/therapeutic use
- Sulfonylurea Compounds/therapeutic use
- Syndrome
- Treatment Outcome
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Affiliation(s)
- Nadia Bahi-Buisson
- Department of Paediatric Neurology and Metabolic Disease, Hôpital Necker Enfants Malades, Paris, France.
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Akabori S, Takano T, Fujito H, Takeuchi Y. West syndrome in a patient with balanced translocation t(X;18)(p22;p11.2). Pediatr Neurol 2007; 37:64-6. [PMID: 17628226 DOI: 10.1016/j.pediatrneurol.2007.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 01/18/2007] [Accepted: 02/26/2007] [Indexed: 11/24/2022]
Abstract
We describe a case of West syndrome with the balanced translocation t(X;18)(p22;p11.2). Treatment with high-dose vitamin B6, adrenocorticotropic hormone, thyrotropin-releasing hormone, and antiepileptic compounds was not effective, and the patient exhibited persistent refractory seizures and severe developmental delays. Although no mutation analysis and X chromosome inactivation were performed, we suggest that the chromosomal abnormality in the present patient is the main etiologic factor responsible for the infantile spasms and severe developmental delay.
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Affiliation(s)
- Shie Akabori
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Shiga, Japan.
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Yoshinaga H, Endo F, Kikumoto K, Inoue T, Oka M, Ohtsuka Y. Epilepsy development in infancy with epileptic discharges. Brain Dev 2007; 29:217-23. [PMID: 17005347 DOI: 10.1016/j.braindev.2006.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 08/18/2006] [Accepted: 08/22/2006] [Indexed: 10/24/2022]
Abstract
As a part of the study to prevent West syndrome (WS) by early treatment, we assessed what kind of epilepsy developed in infants who showed epileptic discharges in early infancy. EEG examinations were performed on 116 infants born from 1997 to September 2004, both before and after 3 months of corrected age (CA). We divided 45 infants who showed epileptic discharges in early infancy into two groups according to the existence of periventricular leukomalacia (PVL) and retrospectively performed the course observation at the survey point on April 1 in 2005. Out of 45 infants showing epileptic discharges in early infancy, 26 developed WS. Compared with infants without PVL, infants with PVL were more likely to develop WS than infants without PVL. Furthermore, infants with PVL were more likely to develop WS than other types of epilepsy. Namely, 11 out of 17 infants with PVL developed WS at the survey point. All infants with WS showed initial epileptic discharges before 5 months of corrected age (CA), and most of them (except for five) had initial epileptic discharges before 3 months of CA. There were two infants who once developed hypsarrhythmia on EEG; however, after starting VPA therapy, they did not develop WS with the improvement of EEG findings, and one was presented here in detail. We proposed that preterm infants with PVL who showed epileptic discharges before 3 months of CA should be treated by antiepileptic drugs to prevent the onset of WS syndrome.
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Affiliation(s)
- Harumi Yoshinaga
- Department of Child Neurology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan.
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Okumura A, Kato T, Sei Y, Suzuki T, Morishita Y, Watanabe K. Popliteal angle in infants with west syndrome. J Child Neurol 2006; 21:898-900. [PMID: 17005110 DOI: 10.1177/08830738060210101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to clarify the relationship between neurologic findings and outcome of patients with West syndrome, focusing on the popliteal angle. The complete neurologic examination, including an assessment of the popliteal angle and muscle tone, was performed on 45 patients with West syndrome. A tight popliteal angle was determined when it was 120 degrees or less. In all 45 patients, abnormal muscle tone was not correlated with any variables. A tight popliteal angle was correlated with seizure persistence, cerebral palsy, and abnormality on magnetic resonance imaging (MRI), as well as severe developmental delay. When limited to the patients with developmental delay, a tight popliteal angle was correlated with severe developmental delay, cerebral palsy, and MRI abnormality, although abnormal muscle tone was not correlated with any items. In the delay group, eight patients had a tight popliteal angle with normal muscle tone. Among them, severe developmental delay was seen in seven (88%), seizure persistence in five (63%), and MRI abnormality in five (63%). These results suggest that a tight popliteal angle might be an indicator of poor neurologic outcome in patients with West syndrome.
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Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Rener-Primec Z, Lozar-Krivec J, Krivec U, Neubauer D. Head growth in infants with infantile spasms may be temporarily reduced. Pediatr Neurol 2006; 35:197-203. [PMID: 16939860 DOI: 10.1016/j.pediatrneurol.2006.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 02/02/2006] [Accepted: 03/20/2006] [Indexed: 11/16/2022]
Abstract
Epileptic activity, as a component of epileptic encephalopathies, can interfere with brain growth and development. Infantile spasms as a syndrome represent such epileptic activity during the period of spasms and hypsarrhythmia. The rate of head growth in infants with infantile spasms during the period of spasms has not been studied previously. A retrospective study of head growth in 38 infants with infantile spasms and no other cause of abnormal head growth is presented. Mental outcome was assessed at follow-up. The mean head circumference of infants with infantile spasms was not significantly smaller than in the normal population, but the proportion of head circumference below the tenth percentile in the infantile spasms group was higher (27%). Head circumference below the tenth percentile in the fourth and fifth month after the onset of infantile spasms was significantly associated with later mental retardation (P = 0.004). There was no correlation with specific treatment of infantile spasms. Transiently diminished head growth in infants with infantile spasms coincides temporally with the onset of infantile spasms and "catches up" during remission of infantile spasms in favorable cases. This pattern can reflect the negative influence of epileptic activity on brain growth during the sensitive period. Head circumference can provide a reliable predictive value of mental outcome in children with infantile spasms.
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Affiliation(s)
- Zvonka Rener-Primec
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, Ljubljana, Slovenia.
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35
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Lin HC, Young C, Wang PJ, Lee WT, Shen YZ. ACTH therapy for Taiwanese children with West syndrome -- efficacy and impact on long-term prognosis. Brain Dev 2006; 28:196-201. [PMID: 16466880 DOI: 10.1016/j.braindev.2005.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 06/28/2005] [Accepted: 07/22/2005] [Indexed: 11/26/2022]
Abstract
To study the efficacy of adrenocorticotrophic hormone (ACTH) in treating Taiwanese children with West syndrome (WS) and the impact on long-term prognosis, 66 patients with WS (54 symptomatic and 12 cryptogenic) were collected from 1987 to 1998 in a medical center in Taiwan. A total of 53 patients were enrolled in this study and treated with ACTH at the dosage of 2.5IU/kg daily for 2 weeks with gradual tapering in subsequent 6 weeks. Immediate responses, side effects of ACTH and long-term outcomes of the patients including seizure and developmental status were evaluated during the average follow-up period of 35.6 months. The spasm-free percentage after one or two courses of ACTH treatment was 77.4%. Nine (17%) patients encountered severe side effects such as major infections, which prompted us to stop ACTH. At the end of follow-up, 22 (41.5%) patients had intractable seizures but 25 (47.2%) patients remained seizure free with or without anticonvulsants. The ACTH-responders had a better chance of remaining seizure free (P<0.05). Regarding the long-term developmental outcome, 12 (22.6%) patients had normal or borderline development; two thirds of them belonged to the crytpogenic group. Six (11.3%) patients expired and 24 (45.3%) were severely retarded; all but one of them belonged to the symptomatic group. The prognosis of WS heavily relies on whether a patient is cryptogenic or symptomatic (P<0.001). Good response to therapy or short treatment lag did not favorably affect the developmental outcomes of the symptomatic cases. We conclude that the long-term outcomes of WS in Taiwan were generally poor despite of treatment. Only cryptogenic patients had favorable prognosis. For symptomatic patients, ACTH therapy may be used to control the spasms and decrease the incidence of subsequent epilepsy, but it will not improve developmental outcome. Considering a high percentage of severe side effects in our study, a lower dosage of ACTH with adequate therapeutic efficacy but less side effects should be considered for treating Taiwanese children with WS.
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Affiliation(s)
- Haung-Chi Lin
- Department of Pediatrics, En Chu Kong Hospital, San-Shia Town, Taipei County, Taiwan, ROC.
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Kondo Y, Okumura A, Watanabe K, Negoro T, Kato T, Kubota T, Hiroko K. Comparison of two low dose ACTH therapies for West syndrome: their efficacy and side effect. Brain Dev 2005; 27:326-30. [PMID: 16023546 DOI: 10.1016/j.braindev.2004.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 08/22/2004] [Accepted: 09/09/2004] [Indexed: 11/27/2022]
Abstract
In order to clarify the appropriate usage of adrenocorticotropic hormone (ACTH), the efficacy and side effects of two different regimens of low dose ACTH therapy were compared. Thirty-four patients with West syndrome (WS) were treated with ACTH. The dose of synthetic ACTH-Z was 0.015 mg/kg/dose in 18 patients who were treated between 1996 and 1998 (regimen A), and 0.010 mg/kg/dose in 16 patients who were treated between 1999 and 2001 (regimen B). Patients were classified into cryptogenic and symptomatic groups. Efficacy and adverse effects of ACTH were compared between regimens A and B. Similar analyses were performed after stratification into cryptogenic and symptomatic groups. The efficacy of ACTH was not different between regimens A and B. However, among patients with symptomatic WS, the number of ACTH injections and the dose of ACTH until cessation of spasms were significantly smaller in regimen A than in regimen B. There was no significant difference in these variables between the regimens among those with cryptogenic WS. Adverse effects were not different between regimens A and B. 0.010 mg/kg per day of ACTH will be adequate for cryptogenic WS, but 0.015 mg/kg per day of ACTH is recommended for symptomatic WS.
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Affiliation(s)
- Yoko Kondo
- Department of pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8560, Japan.
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37
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Tercero MFB, Cabrera López JC, Herrero MM, Rodríguez-Quiñones F. Williams-Beuren syndrome and West “syndrome:” Causal association or contiguous gene deletion syndrome? Am J Med Genet A 2005; 133A:213-5. [PMID: 15633183 DOI: 10.1002/ajmg.a.30486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Munakata M, Haginoya K, Ishitobi M, Sakamoto O, Sato I, Kitamura T, Hirose M, Yokoyama H, Iinuma K. Dynamic cortical activity during spasms in three patients with West syndrome: a multichannel near-infrared spectroscopic topography study. Epilepsia 2004; 45:1248-57. [PMID: 15461679 DOI: 10.1111/j.0013-9580.2004.t01-1-04004.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate spatial and temporal cortical activity during clusters of naturally occurring epileptic spasms in patients with West syndrome (WS) by using multichannel near-infrared spectroscopy (mNIRS). METHODS Conventional magnetic resonance imaging (MRI) and interictal and ictal single-photon emission computed tomography (SPECT) were carried out in three patients with WS. Thereafter, cortical hemodynamics during naturally occurring epileptic spasms were measured by mNIRS with simultaneous video/electroencephalographic (EEG) monitoring. RESULTS Ictal SPECT revealed multiple hyperperfused areas within the cortex. With the use of mNIRS, an increase in regional cerebral blood volume (CBV) was observed in these areas, which is representative of cortical activation. The increase in CBV was accompanied by an increase in the concentrations of both oxy- and deoxyhemoglobin. The following heterogeneous regional changes in CBV during ictus were observed: (a) transient increases that were synchronized with spasms; (b) a gradual increase during an ictal event that fluctuated in synchrony with spasms; and (c) a combination of transient and gradual increases. An increase in regional CBV occurred in multiple areas that were activated either simultaneously or sequentially during an ictal event. Topographic changes in CBV were closely correlated with the phenotype of the spasm. CONCLUSIONS During ictal events, multiple cortical areas were activated simultaneously or sequentially. The pattern of cortical activation closely affected the phenotype of the spasm, which suggested that the cortex was involved in the generation of spasms.
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Affiliation(s)
- Mitsutoshi Munakata
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
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Wang W, Murphy B, Dow KE, David Andrew R, Fraser DD. Systemic adrenocorticotropic hormone administration down-regulates the expression of corticotropin-releasing hormone (CRH) and CRH-binding protein in infant rat hippocampus. Pediatr Res 2004; 55:604-10. [PMID: 14711894 DOI: 10.1203/01.pdr.0000112105.33521.dc] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Systemic adrenocorticotropic hormone (ACTH) administration is a first-line therapy for the treatment of infantile spasms, an age-specific seizure disorder of infancy. It is proposed that exogenous ACTH acts via negative feedback to suppress the synthesis of corticotropin-releasing hormone (CRH), a possible endogenous convulsant in infant brain tissue. The aim of this study was to determine whether systemic ACTH treatment in infant rats down-regulates the hippocampal CRH system, including CRH, CRH-binding protein (CRH-BP), and CRH receptors (CRH-R1 and CRH-R2). Daily i.p. injection of ACTH for 7 consecutive days (postnatal days 3-9) elevated serum corticosterone levels 20-fold measured on postnatal day 10, indicating systemic absorption and circulation of the ACTH. Semiquantitative reverse transcriptase-PCR demonstrated that both CRH and CRH-BP mRNA obtained from the hippocampi of ACTH-injected infant rats was significantly depressed relative to saline-injected animals. Comparable reductions in both CRH and CRH-BP synthesis were further demonstrated with radioimmunoassay. In contrast, neither CRH-R1 nor CRH-R2 mRNA was altered by ACTH treatment, relative to saline-injected rats. This latter finding was confirmed electrophysiologically by measuring the enhancement of hippocampal population spikes by exogenous CRH, also showing no differences between ACTH- and saline-injected rats. The results of this study support the proposal that systemic ACTH treatment down-regulates CRH expression in infant brain, perhaps contributing to the therapeutic efficacy observed during treatment of infantile spasms.
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Affiliation(s)
- Wei Wang
- Department of Paediatrics, Kingston General Hospital, Queen's University, Ontario, Canada
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40
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Chen CC, Chen TF, Lin HC, Oon PC, Wu HM, Wang PJ, Chen THH, Liou HH. Estimation of prevalence and incidence of infantile spasms in Taiwan using capture–recapture method. Epilepsy Res 2004; 58:37-42. [PMID: 15066673 DOI: 10.1016/j.eplepsyres.2003.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Revised: 12/02/2003] [Accepted: 12/15/2003] [Indexed: 11/15/2022]
Abstract
PURPOSE To estimate the prevalence, incidence, and case-fatality of infantile spasms (IS) in Taiwan. METHODS A retrospective cohort of patients with IS was obtained from one medical center to identify 69 IS cases from 1985 to 1997. This cohort, in conjunction with the claimed data from the National Health Insurance, was used to estimate the prevalence and incidence of IS by capture-recapture design, taking the case-fatality of IS into account. RESULTS The prevalence rate of IS for aged 0-9 years was 0.046 per thousand. The incidence rate was estimated as 6 over 100,000 per year in Taiwan. Of the 69 IS cases, 8 deaths were ascertained. The case-fatality rate was 11.6%. The leading cause of death was status epilepticus. CONCLUSIONS We have demonstrated an efficient method to estimate the incidence and prevalence rates of IS in Taiwan. Our results help to make a clear understanding of the disease burden of IS in this society.
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Affiliation(s)
- Chih-Chuan Chen
- Department of Neurology and Pharmacology, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 1, Sec 1, Jan-Ai Road, Taipei 100, Taiwan, ROC
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41
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Hamano SI, Tanaka M, Mochizuki M, Sugiyama N, Eto Y. Long-term follow-up study of West syndrome: Differences of outcome among symptomatic etiologies. J Pediatr 2003; 143:231-5. [PMID: 12970639 DOI: 10.1067/s0022-3476(03)00323-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the outcome of West syndrome and to elucidate the differences in the outcome related to the timing of brain injury. STUDY DESIGN Medical records of 60 patients who were followed regularly for more than seven years were reviewed. The following clinical features were assessed: onset, seizure evolution, electroencephalography and intelligence. Those variables were compared among five groups: cryptogenic, prenatal, preterm, term, and postnatal groups. RESULTS The onset ages of the postnatal group were later than those of the others (P<.05). The relapse after adrenocorticotropic hormone therapy of the preterm group was the earliest among the groups (P<.05). Regarding encelphalography, the ratio of patients with focal discharges was higher in the postnatal group than in the prenatal group (P<.05). The ratios of patients in whom focal epilepsy developed were higher in the term and postnatal group than in the cryptogenic and prenatal group (P<.05). The term group showed similar characteristics to those of the postnatal group. Seven of the 60 had normal intelligence, including three girls with tuberous sclerosis. CONCLUSION The diverse outcomes of West syndrome depending on etiology seemed to be related to the timing of brain injury and brain development.
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Affiliation(s)
- Shin-ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama 339-8551, Japan.
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Saltik S, Kocer N, Dervent A. Magnetic resonance imaging findings in infantile spasms: etiologic and pathophysiologic aspects. J Child Neurol 2003; 18:241-6. [PMID: 12760425 DOI: 10.1177/08830738030180041201] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An etiologic evaluation of 86 patients with infantile spasms is presented and the place of cranial magnetic resonance imaging (MRI) findings within this spectrum is discussed. A total of 103 cranial MRIs, performed between 4 and 72 months of age, were analyzed and classified according to the etiologic and pathophysiologic aspects. Ninety-one percent of cases were diagnosed as symptomatic infantile spasms, and hypoxic-ischemic encephalopathy was the primary cause (30%). The most common involvement was thinning of the corpus callosum in 43 patients (50%), followed by dilation of cerebral ventricles in 32 (36%), delayed myelination in 23 (26.7%), lesions of diencephalic deep gray matter in 17 (19.7%), and enlargement of the subarachnoid space in 12 (14%). Thin corpus callosum and diffuse atrophy were changes mainly associated with hypoxic-ischemic encephalopathy, whereas delayed myelination seemed to be independent from a specific etiology. The results showed that cranial MRI may provide considerable information regarding not only the etiology but also the pathophysiology of infantile spasms.
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Affiliation(s)
- Sema Saltik
- Department of Neurology, Division of Child Neurology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
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43
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Lado FA, Moshé SL. Role of subcortical structures in the pathogenesis of infantile spasms: what are possible subcortical mediators? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2002; 49:115-40. [PMID: 12040889 DOI: 10.1016/s0074-7742(02)49010-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Infantile spasms present a constellation of symptoms and laboratory findings that suggest a role of subcortical circuits in the pathogenesis of this illness. The clinical features of spasms and the influence of subcortical circuits in the regulation of the electroencephologram, along with frequent abnormalities in subcortical structure and functional anatomy, brain stem electrophysiology, sleep regulation, and subcortical neurotransmitter levels, point to the importance of subcortical circuits in the generation of spasms. Furthermore, laboratory evidence shows that modulation of subcortical nuclei may attenuate and ameliorate seizures. We review clinical evidence indicating abnormal function in subcortical circuits and present a hypothesis that the development of infantile spasms requires dysfunction in both cortical and subcortical circuits. The confluence of evidence suggesting a role of subcortical structures in the origin of spasms and laboratory data indicating an anticonvulsant role on some subcortical nuclei raise the possibility of novel approaches to the treatment of infantile spasms.
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Affiliation(s)
- F A Lado
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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44
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Lortie A, Plouin P, Chiron C, Delalande O, Dulac O. Characteristics of epilepsy in focal cortical dysplasia in infancy. Epilepsy Res 2002; 51:133-45. [PMID: 12350389 DOI: 10.1016/s0920-1211(02)00102-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To describe the poorly known characteristics of epilepsy during infancy in focal cortical dysplasia (FCD), one of the most frequent cause of infantile epilepsy. All 28 patients with FCD referred to two specialized centres were retrospectively studied regarding seizure characteristics, psychomotor evaluation, and response to medical and surgical treatment. All patients presented with early partial seizures. Semiology, but not the age of onset, depended on the topography of the dysplasia, with abnormal eye movements in all cases of posterior FCD. Eleven patients also developed infantile spasms (IS), mainly asymmetrical. IS were easily controlled with Vigabatrin or ACTH, but no partial seizures could be medically controlled except in one patient. All patients except one had abnormal neuropsychological findings. Fifteen patients had surgery, eight became seizure free, and seven were significantly improved regarding psychomotor development. Very early and refractory partial seizures, but easily controlled IS are the main characteristics of FCD in infancy. Only the focal ictal semiology may help differentiate the localization of FCD. Its intrinsic epileptogenicity could sustain this clinical pattern. Since the chances for medical control and normal neurodevelopment are poor, surgical treatment should be considered early in infants with FCD.
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Affiliation(s)
- Anne Lortie
- Paediatric Neurology and EEG Services, Hôpital Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Que, Canada H3T 1C5.
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45
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Bouhanick B, Reynier P, Salle A, Ilhouz F, Coutant R, Pouplard F. West syndrome and mitochondrial diabetes: relationship or coincidence? Clin Endocrinol (Oxf) 2002; 57:142-4. [PMID: 12100084 DOI: 10.1046/j.1365-2265.2002.01569_2.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
West syndrome occurs in infancy and in early childhood. It is characterized by intractable seizures occurring almost daily, severe psychomotor retardation, poor prognosis and EEG abnormalities, known as hypsarrhythmia. We report here the case of a 28-year-old patient, who was diagnosed with West syndrome when he was 8 months old and with diabetes mellitus when he was 25 years old. Sequencing analyses and restriction analyses were suggestive of mitochondrial diabetes. Four years after the diagnosis of diabetes, this patient's diabetes is still controlled by diet and biguanides.
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46
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Shah NS, Mitchell WG, Boles RG. Mitochondrial disorders: a potentially under-recognized etiology of infantile spasms. J Child Neurol 2002; 17:369-72. [PMID: 12150585 DOI: 10.1177/088307380201700511] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infantile spasms represent an age-dependent response of the immature brain to a wide variety of insults. An unselected group of children with infantile spasms were reviewed to determine etiology; a metabolic work-up was undertaken if the etiology was unclear from history and examination (cryptogenic). Of the 56 infants, 34 had a recognizable etiology (symptomatic), 1 had normal development (idiopathic), and 21 had cryptogenic infantile spasms. Among the latter, results of plasma lactate and pyruvate or urine organic acids were available in 17. In 2 infants (monozygotic twins), mitochondrial DNA testing revealed the relatively common A3243G mitochondrial mutation. In these twins and 11 of the remaining 15, body fluid metabolite testing suggested possible defective energy metabolism. Our twins and previous reports suggest that mitochondrial disorders should be considered in the differential diagnosis of infantile spasms. Among our cases remaining cryptogenic, signs of abnormal energy metabolism were prevalent, suggesting that metabolic derangements may be common causes or secondary consequences of infantile spasms.
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Affiliation(s)
- Namrata S Shah
- Division of Neurology, Childrens Hospital Los Angeles, CA, USA
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47
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Abstract
Infantile spasms and Lennox-Gastaut syndrome are rare but are important to child neurologists because of the intractable nature of the seizures and the serious neurologic comorbidities. New antiepileptic drugs offer more alternatives for treating both infantile spasms and Lennox-Gastaut syndrome. Selected children with infantile spasms are candidates for epilepsy surgery. Vagus nerve stimulation, corpus callosotomy, and the ketogenic diet are all options for selected children with Lennox-Gastaut syndrome. The epidemiology, clinical manifestations of the seizures, electroencephalographic characteristics, prognosis, and treatment options are reviewed for infantile spasms and Lennox-Gastaut syndrome. Additional therapies are needed for both infantile spasms and Lennox-Gastaut syndrome as many children fail to achieve adequate seizure control in spite of newer treatments.
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Affiliation(s)
- Edwin Trevathan
- Pediatric Epilepsy Center, St. Louis Children's Hospital, MO 63110-1093, USA.
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48
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Juhász C, Chugani HT, Muzik O, Chugani DC. Neuroradiological assessment of brain structure and function and its implication in the pathogenesis of West syndrome. Brain Dev 2001; 23:488-95. [PMID: 11701243 DOI: 10.1016/s0387-7604(01)00295-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neuroimaging studies with magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning have contributed significantly to our understanding of West syndrome. Cortical dysplastic lesions are the most common abnormalities seen with MRI in infants with spasms, but other structural lesions are also detected occasionally. An underlying cortical dysplasia may not be apparent until myelination has advanced in the brain and poor gray-white matter differentiation becomes observable. Many cortical dysplastic lesions can only be detected using PET scanning of glucose metabolism or gamma-aminobutyric acid(A) (GABA(A)) receptor binding. The MRI and PET findings, together with neurophysiological observations, strongly suggest that infantile spasms are initiated as cortical epileptic discharges that, during a 'critical' developmental period, may undergo secondary generalization in an age-dependent mechanism to emerge as spasms. The onset of spasms often coincides with the functional maturation of cerebral cortex. Based on data from glucose metabolism PET scanning as well as electrophysiological and neurochemical findings on infants with spasms, we have postulated that the offending lesion is a focal or diffuse cortical abnormality which, at a critical stage of maturation, causes abnormal functional interactions with brainstem raphe nuclei which project widely throughout the brain. Raphe-cortical projections could mediate the hypsarrhythmic changes seen on EEG. The prominent serotonergic raphe-striatal pathway and descending spinal pathways may be responsible for secondary generalization of the cortical discharges to result in the relatively symmetric spasms. It is likely that additional factors (e.g. genetic) play a role in the manifestation of the age-specific electroclinical features of West syndrome. Recently developed PET tracers can be used to detect epileptogenic brain regions and also to investigate developmental abnormalities of serotonergic (using the tracer alpha[(11)C]methyl-L-tryptophan) and GABAergic (using [(11)C]flumazenil) neurotransmitter systems. These systems are implicated in epileptogenesis, and their involvement in the pathophysiology of West syndrome can be further addressed by future functional neuroimaging studies.
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Affiliation(s)
- C Juhász
- Department of Pediatrics, Children's Hospital of Michigan, The Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Zhongshu Z, Weiming Y, Yukio F, Cheng-LNing Z, Zhixing W. Clinical analysis of West syndrome associated with phenylketonuria. Brain Dev 2001; 23:552-7. [PMID: 11701254 DOI: 10.1016/s0387-7604(01)00260-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the incidence and clinical characteristics of West syndrome associated with phenylketonuria (WS-PKU) and significance of early combination therapy of low phenylalanine (PHE) diet and anticonvulsants (antiepileptic drugs, AEDs) in WS-PKU. SUBJECTS AND METHODS Sixty-two WS-PKU patients (41 boys and 21 girls) out of 503 PKU patients were enrolled in the study. Age at PKU diagnosis varied from 4 months to 7 years old. Serum PHE levels were 20-38.5mg/dl. In the majority of cases, infantile spasms (IS) became manifest first preceding the PKU diagnosis, except eight cases in which spasms appeared after starting the diet therapy. All patients were subjected to mental and electroencephalographic (EEG) examination. Brain myelination was evaluated by using brain magnetic resonance imaging (MRI) with Staudt's standard. RESULTS WS-PKU patients accounted for 12.3% of PKU patients. No patients who were given low PHE diet before age 3 months suffered from WS, whereas 17 out of 156 patients who started the diet between age 4 and 12 months developed WS later (10.9%), and similarly, 45 out of 283 patients who started the diet after 12 months of age developed WS later (15.9%). Moderate and severe mental retardation were noted in 58.8% of patients who received the diet before age 1 and in 84.4% of those after age 1 (P<0.05). EEG displayed hypsarrhythmia and diffuse background abnormality. MRI scans showed delayed myelination mainly in the cerebral lobes and corpus callosum and abnormal high T(2)-signal intensity (100%) in the periventricular region around anterior and posterior horns of both lateral ventricles. With the start of diet, spasms began to decrease its frequency, but relapsed frequently (78%) when no AEDs were given. Seizure relapse was significantly lower when valproic acid or nitrazepam were given concomitantly with the diet (18.2%). CONCLUSIONS IS often occurred as the initial clinical sign of PKU. Early diagnosis of PKU and early therapy with low PHE diet seem to be highly effective in preventing WS.
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Affiliation(s)
- Z Zhongshu
- Pediatric Department, China-Japan Friendship Hospital, Ying Hua Dong Lu 1, He Ping Li, Beijing 100029, People's Republic of China.
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Abstract
In the fall of 2000, the Taiwan Child Neurology Society performed a retrospective survey of West syndrome that occurred in 1998 and 1999 in Taiwan. Questionnaires were sent to the child neurologists in 15 major teaching hospitals or medical centers throughout Taiwan. There were totally 41 cases in these 2 years. Among these 41 cases, 35 had complete data and were enrolled for analysis. The male to female ratio was 1:1.19. The mean age of onset was 6.0+/-4.9 months old. Twenty nine percent were classified as cryptogenic and 71% were symptomatic. Adrenocorticotropic hormone (ACTH) was given to 40% of these patients. The initial response rate was 78.6% and the recurrence rate was 36.4%. For those patients not receiving ACTH, vigabatrin and valproic acid were two of the most common choices. At the final visit, 37% patients remained seizure-free, 29% were still suffering from the same seizure, and 34% changed to other seizure types. The final developmental status was normal in 14%, mildly retarded in 20%, and moderate to severely retarded in 66% of the patients.
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Affiliation(s)
- C Young
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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