Infantile spasms: A prognostic evaluation.
BACKGROUND
Few papers address the comprehensive prognosis in infantile spasms and look into the seizure profile and psychomotor outcome.


OBJECTIVE
We aimed to follow up children with infantile spasms to study: a) the etiology, demographics, semiology, electroencephalogram (EEG), and radiological pattern; b) seizure control, psychomotor development, and EEG resolution with treatment; c) the effects of various factors on the control of spasms, resolution of EEG changes, and psychomotor development at 3-year follow-up.


METHODS
Fifty newly diagnosed cases with a 1-12 month age of onset and who had hypsarrhythmia in their EEG were recruited and 43 were followed up for 3 years.


RESULTS
Of the children followed up, 51% were seizure-free and 37% had a normal EEG at the 3-year follow-up. Autistic features were seen in 74% of the children. Only 22.7% among the seizure-free (11.6% of the total) children had normal vision and hearing, speech with narration, writing skills, gross and fine motor development, and no autism or hyperactivity. On multivariate analysis, two factors could predict bad seizure outcome - the occurrence of other seizures in addition to infantile spasms and no response to 28 days of adrenocorticotropic hormone (ACTH). No predictor could be identified for abnormal psychomotor development.


CONCLUSIONS
In our study, we could demonstrate two factors that predict seizure freedom. The cognitive outcome and seizure control in this group of children are comparable to the existing literature. However, the cognitive outcome revealed by our study and the survey of the literature are discouraging.
Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India.
Mary
M
Iype
Department of Paediatrics, Government Medical College, Trivandrum, Kerala, India.
Geetha
G
Saradakutty
Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India.
Puthuvathra Abdul Mohammed
PA
Kunju
Department of Social and Preventive Medicine, Government Medical College, Trivandrum, Kerala, India.
Devi
D
Mohan
Department of Pediatrics, Child Development Centre, Trivandrum, Kerala, India.
Muttathu Krishnapanicker Chandrasekharan
MK
Nair
Department of Pediatrics, Child Development Centre, Trivandrum, Kerala, India.
Babu
B
George
Department of Paediatrics, Government Medical College, Trivandrum, Kerala, India.
Shahanaz M
SM
Ahamed
Development; West syndrome; cognitive outcome; infantile spasms; outcome; prognosis; psychomotor development; seizure freedom