243 Optimal Therapy in Infantile Spasms

Autor: A Patil, S Masand, A Shah, T Ariyanayagam, M Masand, P Y Xiu
Rok vydání: 2010
Předmět:
Zdroj: Pediatric Research. 68:126-127
ISSN: 1530-0447
0031-3998
DOI: 10.1203/00006450-201011001-00243
Popis: Introduction: Infantile spasms is an epileptic syndrome composed of epileptic seizure, spasms and hypsarrythmia on EEG, associated with psychomotor delay. NICE guidelines offer two first line treatments: hormonal therapy or vigabatrin. Objectives: To analyse current experimental literature, specifically RCTs, comparing vigabatrin with hormonal therapy. The outcomes looked at included spasm control, EEG resolution, relapse rates, subsequent seizures, side effects, and psychomotor delay. Methods: PubMed - searched with MeSH term “infantile spasms”, additional terms; “vigabatrin”, “ACTH” or “tetracosactide”. Results: The combined data from three RCTs comparing vigabatrin with hormonal therapy suggests that in terms of cessation of spasms (OR 0.42, 95%CI 0.21 to 0.80) and EEG resolution (OR 0.38, 95%CI 0.15 to 0.99), hormone treatment is effective in a significantly greater proportion of infants. There was no significant difference in terms of relapse rates, subsequent seizures, number of infants with side effects, and psychomotor development. However, there was a significant improvement in psychomotor development when comparing infants with and without spasm cessation (p=0.008). An RCT comparing vigabatrin with hydrocortisone in tuberous sclerosis patients suggests that vigabatrin is effective in more cases (OR 13.8, 95%CI 2.21 to 86.35) Conclusion: Although these studies are suggestive of clear improvement with hormonal treatment compared to vigabatrin, there is currently a multicentre randomised parallel group study (ICISS; International Collaborative Infantile Spasm Study) which is comparing hormonal and vigabatrin together with hormonal treatment only which will hopefully further clarify the role of hormonal treatment in West syndrome.
Databáze: OpenAIRE
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