title: Infantile spasms: a U.S. consensus report.
abstract: The diagnosis, evaluation, and management of infantile spasms (IS) continue to pose significant challenges to the treating physician. Although an evidence-based practice guideline with full literature review was published in 2004, diversity in IS evaluation and treatment remains and highlights the need for further consensus to optimize outcomes in IS. For this purpose, a working group committed to the diagnosis, treatment, and establishment of a continuum of care for patients with IS and their families—the Infantile Spasms Working Group (ISWG)—was convened. The ISWG participated in a workshop for which the key objectives were to review the state of our understanding of IS, assess the scientific evidence regarding efficacy of currently available therapeutic options, and arrive at a consensus on protocols for diagnostic workup and management of IS that can serve as a guide to help specialists and general pediatricians optimally manage infants with IS. The overall goal of the workshop was to improve IS outcomes by assisting treating physicians with early recognition and diagnosis of IS, initiation of short duration therapy with a first-line treatment, timely electroencephalography (EEG) evaluation of treatment to evaluate effectiveness, and, if indicated, prompt treatment modification. Differences of opinion among ISWG members occurred in areas where data were lacking; however, this article represents a consensus of the U.S. approach to the diagnostic evaluation and treatment of IS.
authors.affiliation: Division of Child Neurology, Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA. jpellock@mcvh-vcu.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Pellock
authors.forename: Richard
authors.initials: R
authors.lastname: Hrachovy
authors.forename: Shlomo
authors.initials: S
authors.lastname: Shinnar
authors.forename: Tallie Z
authors.initials: TZ
authors.lastname: Baram
authors.forename: David
authors.initials: D
authors.lastname: Bettis
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Dlugos
authors.forename: William D
authors.initials: WD
authors.lastname: Gaillard
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Gibson
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Holmes
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Nordl
authors.forename: Christine
authors.initials: C
authors.lastname: O'Dell
authors.forename: W Donald
authors.initials: WD
authors.lastname: Shields
authors.forename: Edwin
authors.initials: E
authors.lastname: Trevathan
authors.forename: James W
authors.initials: JW
authors.lastname: Wheless
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D032921:Consensus; D003245:Consensus Statements as Topic; D055423:Diet, Ketogenic; D018572:Disease-Free Survival; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000592:standards; D017410:Practice Guidelines as Topic; D011239:Prednisolone / Q000627:therapeutic use; D013036:Spasms, Infantile / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D014481:United States; D020888:Vigabatrin / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000927:Anticonvulsants; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D020888:Vigabatrin