Infantile spasms and cytomegalovirus infection: antiviral and antiepileptic treatment.
From 1 January 1995 to 31 December 2004, 22 patients (13 males, nine females; age range 2-12mo) with infantile spasms and cytomegalovirus (CMV) infection were treated with intravenous ganciclovir (GCV) and antiepileptic drugs. GCV was given for 3 to 12 weeks with a 1-month interval (one, two, or three courses). Epileptic spasms occurred before (group A: eight patients), simultaneously (group B: eight patients), and after (group C: six patients) a diagnosis of human CMV (HCMV) infection and antiviral treatment. In 11 patients, DNA CMV [corrected] was found in cerebrospinal fluid by nested-polymerase chain reaction method (neuroinfection). All infants excreted CMV in urine. DNA CMV [corrected] and specific immunoglobulin M and immunoglobulin G antibodies were present in blood. Ten patients, including four with neuroinfection, have been seizure-free for at least the past 18 months. In two patients with neuroinfection, vigabatrin monotherapy was withdrawn after a 2 year 6 month seizure-free period. Eighteen patients required antiepileptic drugs polytherapy, four of whom required additional adrenocorticotropic hormone (ACTH). Six patients on polytherapy were seizure-free on follow-up, two of whom were treated with ACTH, but one patient [corrected] who required ACTH [corrected] was seizure-free on follow-up. In five patients, psychomotor development was normal, 16 had tetraplegia (Gross Motor Function Classification System [GMFCS] Level V), and one had diplegia (GMFCS Level III). Early antiviral and antiepileptic therapy could result in the long-term cessation of seizures.
Dunin-Wasowicz
Dorota
D
Neurology and Epileptology Department, The Children's Memorial Health Institute, Warsaw, Poland. ddwasowicz@wp.pl
Kasprzyk-Obara
Jolanta
J
Jurkiewicz
Elzbieta
E
Kapusta
Monika
M
Milewska-Bobula
Bogumila
B
D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D006429:Hemiplegia / Q000821:virology; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D011597:Psychomotor Performance; D011782:Quadriplegia / Q000821:virology; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D016896:Treatment Outcome; D020888:Vigabatrin / Q000627:therapeutic use
D000927:Anticonvulsants; D000998:Antiviral Agents; D004279:DNA, Viral; D000324:Adrenocorticotropic Hormone; D020888:Vigabatrin; D015774:Ganciclovir