title: Prognostic factors of infantile spasms: role of treatment options including a ketogenic diet.
abstract: OBJECTIVE
  The aim of this study was to provide additional evidences on prognostic factors for infantile spasms and the possible role of a ketogenic diet.
  
  
  METHODS
  A retrospective analysis was performed for patients with infantile spasms who had been followed up for more than 6months between January 2000 and July 2012 at Samsung Medical Center (Seoul, Republic of Korea). We analyzed the association between possible prognostic factors and seizure/developmental outcomes.
  
  
  RESULTS
  Sixty-nine patients were included in this study and their mean follow-up duration was 52.5 (9-147) months. In the patients who had been followed up for more than 2years, 53.6% (n=30/57) remained seizure-free at the last visit. Sixty patients (86.9%) showed developmental delay at last follow-up. Forty-two patients (60.9%) became spasm-free with one or two antiepileptic drugs, one patient with epilepsy surgery for a tumor, and seven patients with a ketogenic diet after the failure of two or more antiepileptic drugs. The etiology and age of seizure onset were the significant prognostic factors.
  
  
  CONCLUSIONS
  In this study, about 60% of the patients became spasm-free with vigabatrin and topiramate. Ketogenic diet increased the rate by 10% in the remaining antiepileptic drug resistant patients. However, 86.9% of the patients showed developmental delay, mostly a severe degree. Early diagnosis and prompt application of treatment options such as antiepileptic drugs, a ketogenic diet or epilepsy surgery can improve outcomes in patients with infantile spasms.
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. jhlee0101@skku.edu
authors.forename: Jeehun
authors.initials: J
authors.lastname: Lee
authors.forename: Jun Hwa
authors.initials: JH
authors.lastname: Lee
authors.forename: Hee Jun
authors.initials: HJ
authors.lastname: Yu
authors.forename: Munhyang
authors.initials: M
authors.lastname: Lee
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D055423:Diet, Ketogenic / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000178:diet therapy* / Q000188:drug therapy; D016896:Treatment Outcome; D020888:Vigabatrin / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D020888:Vigabatrin
keywords: Development; Infantile spasms; Ketogenic diet; Levetiracetam; Outcome; Topiramate; Valproate; Vigabatrin