Departments: The Waiting Room
New guideline from the American Academy of Neurology
The American Academy of Neurology (AAN) has released an updated, evidence-based guideline for the treatment of infantile spasms, a type of seizure disorder that develops during the first year of life.
Infantile spasms are usually very brief, lasting just a few seconds, and involve sudden, involuntary movements of the upper body, neck, arms, and legs.
“When we issued our first guideline on infantile spasms in 2004, not enough studies existed to tell us whether or not treatment in the short term affected long-term outcomes in these children,” says Cristina Y. Go, M.D., a neurologist at Toronto's Hospital for Sick Children and the lead author of the updated guideline.
After reviewing an additional eight years' worth of evidence, the AAN found that the data still pointed to only two effective treatments for infantile spasms: adrenocorticotropic hormone (ACTH), an injectable medication that may work by stimulating the body to produce natural hormones like cortisol, and the antiepileptic drug (AED) vigabatrin.
The new AAN guideline reports that lower doses of ACTH appear to be equally effective at controlling the spasms, with fewer side effects such as infections and high blood pressure. This is particularly important because such side effects can be severe, and even fatal.
With eight more years of data, the researchers were also able to study the development of babies treated for infantile spasms as they grew. Two types of infantile spasms exist: those with a known cause, such as a neonatal stroke or tuberous sclerosis (a genetic disorder in which non-cancerous tumors grow on the brain and other vital organs); and those labeled “cryptogenic” because the baby appears developmentally normal before the spasms start and tests find no underlying cause.
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“Overall, we found no difference in developmental outcomes between children treated with ACTH and those treated with vigabatrin,” says Dr. Go. “But in the cryptogenic group, those who received hormonal therapy had much better developmental outcomes at four years of age than those who received vigabatrin.”
No matter which treatment they received—hormonal therapy or vigabatrin—children treated within one month of the time their seizures first appeared had better outcomes than those treated much later. “If a child is suspected of infantile spasms, it's important to quickly get proper assessment and treatment,” says Dr. Go. “Many times infantile spasms get missed, or are mislabeled as colic or reflux, until the child starts losing milestones months down the line. We might still successfully treat the spasms then, but the long-term outcomes won't be as good.”
If you think your baby may be showing signs of infantile spasms, go to infantilespasmscenter.org/infantile-spasms-questionnaire.