Is there any treatment for infantile spasms (IS)?

Shaun A. Hussain, MD
To treat infantile spasms (IS) adrenocorticotropic hormone (ACTH) is the most popular first-line therapy in the United States, but internationally, prednisolone and vigabatrin (Sabril) dominate the field. There have not been adequate studies comparing the best doses of ACTH and prednisolone.

Our current treatment protocol is as follows: Upon confirmation of diagnosis with video_EEG, we begin simultaneous prednisolone and vigabatrin. If this has not worked within two weeks, we will switch the prednisolone to ACTH and give that an additional two weeks. If that is not successful, then other things will be tried. There is a lot of variety in the way doctors approach infantile spasms. The take-home message is not necessarily the sequence but that doctors act quickly and don't delay therapy. If any given therapy isn't working, it should be switched after a couple of weeks because time is of the essence.

Zonisamide (Zonegran) and topiramate (Topamax) are both relatively inexpensive therapies. These are common anti-seizure drugs that have a broad spectrum of action. They may be a little bit effective in treating infantile spasms. Zonisamide and topiramate have a risk of kidney stones and can also cause reduced appetite.

On the whole, other drugs are not game changers. Some drugs either are known to be ineffective or may present some risk that they might cause infantile spasms to get worse, or they might actually cause the development of infantile spasms in children who are at risk.

When infantile spasms are thought to be caused by a focal brain abnormality, some patients are candidates for a surgery in which the abnormality is simply removed. This seems dramatic at first glance, but outcomes among surgical candidates tend to be excellent, and these patients have much lower relapse rates in comparison to children who respond to all other available medications.

Treatment with corticosteroids, such as prednisone, is standard for infantile spasms (ISs), although serious side effects can occur. Several newer antiepileptic medications, such as topiramate, may ease some symptoms. Some children have spasms as the result of brain lesions, and surgical removal of these lesions may result in improvement.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

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