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Ren LH, Zhang J, Li SX, Liu P, Chen H, Hu W. Infantile epileptic spasms syndrome: a cohort study of 88 children. Ital J Pediatr 2023; 49:159. [PMID: 38041198 PMCID: PMC10693141 DOI: 10.1186/s13052-023-01563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND This study aimed to investigate and analyze the risk factors for non-etiology-specific infantile spasms (IS) and unrelieved clinical symptoms after treatment. METHODS Eighty-eight children with IS who were treated at our hospital from March 2018 to December 2021 were included in the study. The children were divided into etiology-specific (n = 46) and nonetiology-specific (n = 42) groups, based on the diagnostic results, and remission (n = 45) and nonremission (n = 43) groups, based on clinical outcomes after treatment. The clinical data from patients in the etiology-specific and nonetiology-specific groups and the remission and nonremission groups were compared. Risk factors for non-etiology-specific IS were identified using logistic regression analysis. RESULTS Gender, family history, birth status, and metabolic abnormalities were significantly different between the etiology-specific and non-etiology-specific groups. Gender and metabolic abnormalities were risk factors for nonetiology-specific IS. Family history, birth status, metabolic abnormalities, and brain magnetic resonance imaging were significantly different between the remission and nonremission groups, and different etiologies were risk factors for unrelieved symptoms after treatment. CONCLUSION The occurrence of nonetiology-specific IS is associated with gender and metabolic abnormalities in children. After medication, unrelieved IS symptoms are associated with etiologies.
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Affiliation(s)
- Li-Hong Ren
- Department of Pediatric Neurology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, No. 1617, Riyue Aveneue, Chengdu, 611731, China
| | - Jing Zhang
- Department of Pediatric Neurology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, No. 1617, Riyue Aveneue, Chengdu, 611731, China
| | - Si-Xiu Li
- Department of Pediatric Neurology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, No. 1617, Riyue Aveneue, Chengdu, 611731, China
| | - Ping Liu
- Department of Pediatric Neurology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, No. 1617, Riyue Aveneue, Chengdu, 611731, China
| | - Hui Chen
- Department of Pediatric Neurology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, No. 1617, Riyue Aveneue, Chengdu, 611731, China
| | - Wenguang Hu
- Department of Pediatric Neurology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, No. 1617, Riyue Aveneue, Chengdu, 611731, China.
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Kanai S, Oguri M, Okanishi T, Miyamoto Y, Maeda M, Yazaki K, Matsuura R, Tozawa T, Sakuma S, Chiyonobu T, Hamano SI, Maegaki Y. Quantitative pretreatment EEG predicts efficacy of ACTH therapy in infantile epileptic spasms syndrome. Clin Neurophysiol 2022; 144:83-90. [PMID: 36327598 DOI: 10.1016/j.clinph.2022.10.004] [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: 07/13/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to determine the correlation between outcomes following adrenocorticotrophic hormone (ACTH) therapy and measurements of relative power spectrum (rPS), weighted phase lag index (wPLI), and graph theoretical analysis on pretreatment electroencephalography (EEG) in infants with non-lesional infantile epileptic spasms syndrome (IESS). METHODS Twenty-eight patients with non-lesional IESS were enrolled. Outcomes were classified based on seizure recurrence following ACTH therapy: seizure-free (F, n = 21) and seizure-recurrence (R, n = 7) groups. The rPS, wPLI, clustering coefficient, and betweenness centrality were calculated on pretreatment EEG and were statistically analyzed to determine the correlation with outcomes following ACTH therapy. RESULTS The rPS value was significantly higher in the delta frequency band in group R than in group F (p < 0.001). The wPLI values were significantly higher in the delta, theta, and alpha frequency bands in group R than in group F (p = 0.007, <0.001, and <0.001, respectively). The clustering coefficient in the delta frequency band was significantly lower in group R than in group F (p < 0.001). CONCLUSIONS Our findings demonstrate the significant differences in power and functional connectivity between outcome groups. SIGNIFICANCE This study may contribute to an early prediction of ACTH therapy outcomes and thus help in the development of appropriate treatment strategies.
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Affiliation(s)
- Sotaro Kanai
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago 683-8503, Japan.
| | - Masayoshi Oguri
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, 281-1 Mure-cho, Takamatsu 761-0123, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Yosuke Miyamoto
- Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masanori Maeda
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Kotaro Yazaki
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku. Saitama 330-8777, Japan
| | - Takenori Tozawa
- Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoru Sakuma
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomohiro Chiyonobu
- Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku. Saitama 330-8777, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago 683-8503, Japan
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Jiang Y, Zou N, Luo Y, Cheng M, Liao S, Hong S, Liang X, Zhong M, Li T, Jiang L. Cohort study of infantile epileptic spasms syndrome: etiological analysis and treatment of corticosteroids. Seizure 2022; 101:120-126. [DOI: 10.1016/j.seizure.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/24/2022] [Accepted: 07/30/2022] [Indexed: 11/13/2022] Open
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Li L, Lin S, Tan Z, Chen L, Zeng Q, Sun Y, Li C, Liu Z, Lin C, Ren X, Zhang T, Li Y, Su Q, Li Y, Cao D, Liao J, Zhu F, Chen Y. Resective epilepsy surgery for West syndrome: The Hypsarrhythmic Asymmetric Scoring Scheme is a determining predictor of seizure outcome. Seizure 2022; 101:205-210. [PMID: 36084526 DOI: 10.1016/j.seizure.2022.08.011] [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: 06/17/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE It has been suggested that asymmetric hypsarrhythmia is associated with structural etiology. We devised the Hypsarrhythmic Asymmetric Scoring Scheme (HASS) to quantify the degree of hypsarrhythmic asymmetry in a retrospective series of patients who underwent surgical treatment at our center. The present study aimed to investigate the role of HASS in predicting the postsurgical seizure outcomes. METHODS We retrospectively analyzed the records of 46 children with hypsarrhythmia who underwent resective epilepsy surgery between 2018 and 2020 and were followed up for at least 1 year after surgery. Hypsarrhythmia severity in each hemisphere was quantified and scored. The HASS score was calculated as the difference between the two hemispheres. Univariate results were submitted to logistic regression models to identify independent predictors for favorable surgical outcomes. RESULTS Of the 46 patients who underwent resective surgery, Engel's class I-Ⅱ outcomes were achieved in 34 (73.9%). The Engel I-Ⅱ group had a significantly higher HASS score than the Engel Ⅲ-Ⅳ group (p<0.001). Multivariate analysis showed that the HASS score was the only significant predictor of good outcomes (p = 0.011). Further receiver operating characteristic analysis showed that a threshold of 7 yielded a better seizure outcome with a sensitivity of 97.06% and specificity of 83.33%. SIGNIFICANCE As the first hypsarrhythmia scoring system specially designed for presurgical evaluation, the HASS score may contribute to predicting the postsurgical seizure outcome from the electroencephalography perspective.
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Affiliation(s)
- Lin Li
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Sufang Lin
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Zeshi Tan
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Li Chen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Qi Zeng
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Yang Sun
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Cong Li
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Zhenzhen Liu
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Chun Lin
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Xiaofan Ren
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Tian Zhang
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Ying Li
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Qiru Su
- Department of Clinical Research, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Yilian Li
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Dezhi Cao
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China; Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Jianxiang Liao
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China; Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Fengjun Zhu
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China.
| | - Yan Chen
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China.
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Effectiveness of ACTH in Patients with Infantile Spasms. Brain Sci 2022; 12:brainsci12020254. [PMID: 35204017 PMCID: PMC8870252 DOI: 10.3390/brainsci12020254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: West syndrome is a severe, refractory, epileptic syndrome that usually appears in infancy or early childhood. ACTH is one of the more effective drugs for treating this condition. (2)Aim of the study and methods: The objective of our study was to examine short-term efficacy (during treatment schedule) and long-term outcome of intramuscular 0.02 mg/kg/day ACTH (tetracosactide) depot, used concomitantly with other antiepileptic drugs (AEDs) in patients with infantile spasms who did not achieve seizure cessation or relapse when taking only the AEDs. The drug efficacy was evaluated in retrospective and prospective analyses of 50 patients diagnosed with infantile spasms. (3) Results: Complete cessation of spasms was achieved in 42 cases (84%). EEG improvement was seen in 41 (82%) patients who responded to ACTH therapy. Information on the clinical course of 28 patients was obtained duringlong-term follow-up. In 17 (60.7%) cases, seizures were still present. Normal or near-normal development was observed in 11 out of 28 children (39%). ACTH used concomitantly with other AEDis a highly effective treatment with acceptable side effects. (4) Conclusion: Randomized controlled clinical trialswith long-term follow-up are needed to compare the effectiveness of ACTH in polytherapy and monotherapy.Dyskinesias as a potential side effect observed in our study group should be investigated in the following studies.
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Swanson LC, Ahmed R. Epilepsy Syndromes: Current Classifications and Future Directions. Neurosurg Clin N Am 2021; 33:113-134. [PMID: 34801136 DOI: 10.1016/j.nec.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This review describes the clinical presentations and treatment options for commonly recognized epilepsy syndromes in the pediatric age group, based on the 2017 International League Against Epilepsy classification. Structural epilepsies that are amenable to surgical intervention are discussed. Lastly, emerging technologies are reviewed that are expanding our knowledge of underlying epilepsy pathologies and will guide future syndromic classification systems including genetic testing and tissue repositories.
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Affiliation(s)
- Laura C Swanson
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. #18, Chicago, IL 60611, USA
| | - Raheel Ahmed
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, 1675 Highland Avenue #0002, Madison, WI 53705, USA.
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Srivastava R, Shaw OEF, Armstrong E, Morneau-Jacob FD, Yager JY. Patterns of Brain Injury in Perinatal Arterial Ischemic Stroke and the Development of Infantile Spasms. J Child Neurol 2021; 36:583-588. [PMID: 33543672 DOI: 10.1177/0883073820986056] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Perinatal arterial ischemic stroke (PAIS) underlies approximately 10% of infantile spasms (IS). We aim to identify patterns of brain injury in ischemic stroke that may predispose infants to infantile spasms. METHODS Sixty-four perinatal arterial ischemic stroke patients were identified meeting the following inclusion criteria: term birth, magnetic resonance imaging (MRI) showing ischemic stroke or encephalomalacia in an arterial distribution, and follow-up records. Patients who developed infantile spasms (PAIS-IS) were analyzed descriptively for ischemic stroke injury patterns and were compared to a seizure-free control group (PAIS-only). Stroke injury was scored using the modified pediatric ASPECTS (modASPECTS). RESULTS The PAIS-IS (n = 9) group had significantly higher modASPECTS than the PAIS-only (n = 16) group (P = .002, Mann-Whitney). A greater proportion of PAIS-IS patients had injury to deep cerebral structures (67%) than PAIS-only (25%). CONCLUSION Infarct size was significantly associated with infantile spasms development. Results support theories implicating deep cerebral structures in infantile spasms pathogenesis. This may help identify perinatal arterial ischemic stroke patients at risk of infantile spasms, facilitating more timely diagnosis.
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Affiliation(s)
- Ratika Srivastava
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Oriana E F Shaw
- Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Edward Armstrong
- Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Francois-Dominique Morneau-Jacob
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
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Risks of ACTH therapy for West syndrome following BCG vaccination. Epilepsy Behav 2021; 118:107924. [PMID: 33838621 DOI: 10.1016/j.yebeh.2021.107924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Bacille de Calmette et Guérin (BCG) is a live vaccine for tuberculosis that is administered to all infants in Japan. Adrenocorticotropic hormone (ACTH) therapy for West syndrome (WS) causes immunosuppression and may result in BCG infection after BCG vaccination. We evaluated the safety of ACTH therapy initiated shortly after BCG vaccination. METHODS We analyzed patients with WS who received ACTH therapy between 2005 and 2018. We evaluated the interval between BCG and ACTH therapy, and the rate of BCG infection during and after ACTH therapy, by retrospective chart review. RESULTS Seventy-nine patients were included in the analysis. Twenty-three patients received ACTH therapy prior to BCG vaccination. For the remaining 56 patients, the median interval between BCG vaccination and the start of ACTH therapy (BCG-ACTH interval) was 91.5 (range 14-280) days. The BCG-ACTH interval was shorter in patients with unknown than in those with known etiologies. It was <8 weeks in 13 patients (10 with unknown and 3 with known etiologies). The minimum BCG-ACTH interval was 14 days. Six patients with epileptic spasms received BCG vaccinations because physicians did not recognize their seizures. None of the patients developed BCG infection. CONCLUSION No patients who received ACTH therapy after BCG, even at an interval of 8 weeks, developed BCG infection. The timing of ACTH therapy initiation should be based on the risk of BCG-related adverse events and the adverse effects of any delay.
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Pavone P, Polizzi A, Marino SD, Corsello G, Falsaperla R, Marino S, Ruggieri M. West syndrome: a comprehensive review. Neurol Sci 2020; 41:3547-3562. [PMID: 32827285 PMCID: PMC7655587 DOI: 10.1007/s10072-020-04600-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
Since its first clinical description (on his son) by William James West (1793–1848) in 1841, and the definition of the classical triad of (1) infantile spasms; (2) hypsarrhythmia, and (3) developmental arrest or regression as “West syndrome”, new and relevant advances have been recorded in this uncommon disorder. New approaches include terminology of clinical spasms (e.g., infantile (IS) vs. epileptic spasms (ES)), variety of clinical and electroencephalographic (EEG) features (e.g., typical ictal phenomena without EEG abnormalities), burden of developmental delay, spectrum of associated genetic abnormalities, pathogenesis, treatment options, and related outcome and prognosis. Aside the classical manifestations, IS or ES may present with atypical electroclinical phenotypes (e.g., subtle spasms; modified hypsarrhythmia) and may have their onset outside infancy. An increasing number of genes, proteins, and signaling pathways play crucial roles in the pathogenesis. This condition is currently regarded as a spectrum of disorders: the so-called infantile spasm syndrome (ISs), in association with other causal factors, including structural, infectious, metabolic, syndromic, and immunologic events, all acting on a genetic predisposing background. Hormonal therapy and ketogenic diet are widely used also in combination with (classical and recent) pharmacological drugs. Biologically targeted and gene therapies are increasingly studied. The present narrative review searched in seven electronic databases (primary MeSH terms/keywords included West syndrome, infantile spasms and infantile spasms syndrome and were coupled to 25 secondary clinical, EEG, therapeutic, outcomes, and associated conditions terms) including MEDLINE, Embase, Cochrane Central, Web of Sciences, Pubmed, Scopus, and OMIM to highlight the past knowledge and more recent advances.
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Affiliation(s)
- Piero Pavone
- Unit of Clinical Pediatrics, AOU "Policlinico", PO "G. Rodolico", University of Catania, Catania, Italy
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Giovanni Corsello
- Unit of Pediatrics and Neonatal Intensive Therapy, Department of Promotion of Maternal and Infantile and Internal Medicine Health, and Specialist Excellence "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Neonatal Intensive Therapy, Department of Promotion of Maternal and Infantile and Internal Medicine Health, and Specialist Excellence "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Silvia Marino
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, AOU "Policlinico", PO "G. Rodolico", Via S. Sofia, 87, 95128, Catania, Italy.
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Sumanasena SP, Wanigasinghe J, Arambepola C, Sri Ranganathan S, Muhandiram E. Developmental profile at initial presentation in children with infantile spasms. Dev Med Child Neurol 2019; 61:1295-1301. [PMID: 30854631 DOI: 10.1111/dmcn.14205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
AIM To describe the baseline developmental profile and influence of clinical and demographic factors on the developmental skills of infants diagnosed with infantile spasms. METHOD Ninety-five infants (55 males, 40 females) newly diagnosed with infantile spasms were recruited for a cross-sectional, longitudinal study. All infants underwent Bayley Scales of Infant and Toddler Development assessments in the cognitive, receptive communication, expressive communication, and fine and gross motor developmental domains; they also underwent visual, auditory, and social behaviour assessments. Infants were categorized as 'early' (<6mo) or 'late' (≥6mo) presenters; if presented within 28 days, this was considered as 'early presentation', whereas a delay greater than 28 days was considered as a 'delay in presentation'. Antenatal, perinatal, and postnatal risk factors were identified. RESULTS Over 90% of infants showed impairment in all domains, with the majority having severe delay; 99% showed cognitive impairment. Delayed presentation was significantly associated with receptive communication delay (odds ratio [OR]=5.35; 95% confidence interval [CI]=1.05-27.32). Onset at 6 months or less influenced auditory (OR=2.8; 95% CI=1.16-6.8) and visual (OR=3.03; 95% CI=1.22-7.57) behaviours. Neonatal infections impacted both receptive (OR=1.12; 95% CI=1.04-1.2) and expressive communication (OR=1.08; 95% CI=1.02-1.14) delay. Neonatal seizures significantly influenced visual, auditory, and social impairments. Expressive communication and gross motor development shared common perinatal risk factors. INTERPRETATION Adverse developmental status at presentation, associated with delayed presentation and neonatal risk factors should alert clinicians to the surveillance of at-risk infants and seek out timely interventions. WHAT THIS PAPER ADDS Ninety per cent of infants showed impaired cognitive, communication, and motor skills at presentation. Visual, auditory, and social behaviour impairments were significantly associated with perinatal risks. Visual, auditory, and social behaviour impairments were significantly associated with neonatal seizures.
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Affiliation(s)
- Samanmali P Sumanasena
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Eindrini Muhandiram
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Lockrow JP, Wright JN, Saneto RP, Amlie-Lefond C. Epileptic Spasms Predict Poor Epilepsy Outcomes After Perinatal Stroke. J Child Neurol 2019; 34:830-836. [PMID: 31339419 DOI: 10.1177/0883073819863278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perinatal stroke is a significant cause of severe epilepsy, including epileptic spasms. Although epileptic spasms due to underlying structural lesion often respond poorly to treatment and evolve into drug-resistant epilepsy, outcomes are not uniformly poor, and predictors of outcomes are not well described. We performed a single-institution retrospective review of epileptic spasms following perinatal stroke to determine if outcome depended on vascular subtype. We identified 24 children with epileptic spasms due to perinatal ischemic stroke: 11 cases of perinatal arterial stroke and 13 cases of perinatal venous infarct. Initial response to treatment was similar between groups; however, although children with perinatal arterial stroke who responded to epileptic spasms therapy had high rates of seizure freedom, many children with perinatal venous infarct, regardless of initial response, had residual drug-resistant epilepsy. We consider whether the mechanism for epileptogenesis may be different between arterial and venous strokes, and whether these 2 groups should be monitored for epileptic spasms, and subsequent epilepsy, differently.
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Affiliation(s)
- Jason P Lockrow
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
| | - Jason N Wright
- Department of Neurology, Section of Neuroradiology, University of Washington, Seattle, WA, USA
| | - Russell P Saneto
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
| | - Catherine Amlie-Lefond
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
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Alqassas MA, Muthaffar OY, Aljawi AA, Taj AM, Nijaifan HK, Alyoubi RA, Jan MM. Treatment of infantile spasms in Saudi Arabia. ACTA ACUST UNITED AC 2019; 23:258-261. [PMID: 30008006 PMCID: PMC8015583 DOI: 10.17712/nsj.2018.3.20180015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: To evaluate the treatment approach and compliance of pediatric neurologists with evidence-based guidelines across Kingdom of Saudi Arabia (KSA). These guidelines that clarify the optimal management of infantile spasms (IS) are not widely followed for various practical reasons. Methods: Physicians practicing in the field of pediatric neurology in KSA were contacted from the database of national societies. A cross-sectional study was conducted using a structured 20-item on-line survey designed to examine their clinical experience with IS and their treatment choices. Results: A total of 52 pediatric neurologists completed the survey (69% estimated capture rate). They received their formal training within KSA (40%), North America (33%), or Europe (14%). The majority practiced in 2 major cities, Riyadh (46%) or Jeddah (19%). Vigabatrin was favored over adrenocorticotropic hormone (ACTH) as first line drug for patients without tuberous sclerosis complex (48% vs. 21%). Several factors correlated with correctly selecting ACTH as first line including western training (33% vs. 5%, p=0.001), practicing in the city of Riyadh (25% vs. 14%, p=0.001), or having >10 years of clinical experience (25% vs. 5%, p=0.017). Reasons for not complying with the recommended treatment guidelines included lack of availability of ACTH (42%), side effect profile of steroids (29%), and personal preferences (14%). Only 4% admitted lack of awareness of the currently published management guidelines. Conclusion: Many pediatric neurologists in KSA are not following the published IS management guidelines. Using ACTH as first line correlated with their training, practice location, and years of experience. Lack of drug availability and side effect profile were common reasons for not complying with the management guidelines.
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Affiliation(s)
- Maryam A Alqassas
- Departments of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Yoon DH, Moon JU, Lee JY, Lee IG. Reconsideration of Vigabatrin Effect in Infantile Spasms Treatment. ANNALS OF CHILD NEUROLOGY 2019. [DOI: 10.26815/acn.2019.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ben Abdelaziz R, Ben Chehida A, Lamouchi M, Ben Messaoud S, Ali Mohamed D, Boudabous H, Abdelmoula M, Azzouz H, Tebib N. Factors predictive of prognosis of infantile spasms. A retrospective study in a low-income country. Arch Pediatr 2019; 26:1-5. [DOI: 10.1016/j.arcped.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 09/12/2018] [Accepted: 10/14/2018] [Indexed: 10/27/2022]
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