Infantile spasms: a U.S. consensus report.
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.
Pellock
John M
JM
Division of Child Neurology, Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA. jpellock@mcvh-vcu.edu
Hrachovy
Richard
R
Shinnar
Shlomo
S
Baram
Tallie Z
TZ
Bettis
David
D
Dlugos
Dennis J
DJ
Gaillard
William D
WD
Gibson
Patricia A
PA
Holmes
Gregory L
GL
Nordl
Douglas R
DR
O'Dell
Christine
C
Shields
W Donald
WD
Trevathan
Edwin
E
Wheless
James W
JW
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
D000305:Adrenal Cortex Hormones; D000927:Anticonvulsants; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D020888:Vigabatrin