title: Outcomes of epileptic spasms in patients aged less than 3 years: single-center United States experience.
abstract: Retrospective review was performed of children aged <3 years with epileptic spasms at our center from 2004-2010. Short-term (<6 months) and long-term (≥6 months) outcomes were assessed. We included 173 children (104 boys; median age of onset, 6.8 months) with epileptic spasms of known (62%) and unknown (38%) etiology. Treatments included adrenocorticotropic hormone (n = 103), vigabatrin (n = 82), phenobarbital (n = 34), and other agents (n = 121). Short-term treatment with adrenocorticotropic hormone and vigabatrin provided better epileptic spasm control in groups with known and unknown etiology than other agents. At follow-up (6-27 months), 54% of children manifested seizures, and 83% manifested developmental delay. Known etiology was a predictor of poor developmental outcome (P = 0.006), whereas bilateral/diffuse brain lesions predicted both poor development and seizures (P = 0.001 and 0.005, respectively). Initial presentations of epileptic spasms with hypotonia or developmental delay most strongly predicted both seizures and neurodevelopmental outcomes (P < 0.001). In a child presenting with epileptic spasms with developmental delay or hypotonia, no specific treatment may offer superior benefit.
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Martina
authors.initials: M
authors.lastname: Vendrame
authors.forename: Laura M F F
authors.initials: LM
authors.lastname: Guilhoto
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.forename: Matt
authors.initials: M
authors.lastname: Gregas
authors.forename: Blaise F
authors.initials: BF
authors.lastname: Bourgeois
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Kothare
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010634:Phenobarbital / Q000627:therapeutic use; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D020888:Vigabatrin / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D000324:Adrenocorticotropic Hormone; D020888:Vigabatrin; D010634:Phenobarbital