pediatrics
Infantile Spasms
Treatment of Infantile Spasms
Intramuscular adrenocorticotropic hormone (ACTH) Oral corticosteroids Vigabatrin(especially for tuberous sclerosis complex) Infantile spasms are not responsive to typical antiseizure medications. The standard therapies for infantile spasms can be any one of the following. ACTHcan be given daily IM as either high-dose (150 units/m2) ACTH or low-dose (20 units/m2) ACTH. The Pediatric Epilepsy Research Consortium (PERC) recommends the higher dose, given for 2 weeks and then tapered down every 3 days until 29 days of treatment are completed. If low-dose therapy is tried and has not stopped spasms within 2 weeks, the higher dose is used. Corticosteroids(eg, oralprednisone) are given for 4 to 7 weeks. A regimen recommended by PERC uses oralprednisoloneas follows: Days 1 to 14: 10 mg 4 times a day Days 15 to 19: 10 mg 3 times a day Days 20 to 24: 10 mg 2 times a day Days 25 to 29: 10 mg once a day is the drug of choice when the spasms are caused by Tuberous Sclerosis Complex (TSC) . It is also often used in children with an established preexisting serious brain injury or malformation and in those who do not tolerate or respond to ACTH. Dosage of oral In some patients with resistant spasms or with focal cortical malformation, Surgery can eliminate seizures. There is evidence that the more quickly effective therapy is initiated, the better the neurodevelopmental outcome, particularly when no cause is identified. Knupp KG, Coryell J, Nickels KC, et al: Response to treatment in a prospective national infantile spasms cohort.Ann Neurol79(3):475–484, 2016. doi: 10.1002/ana.24594 