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Guideline issued for treatment of infantile spasms

26 May, 2004

A new guideline, developed by the American Academy of Neurology and the Child Neurology Society, for the treatment of infantile spasms has been published in the journal Neurology.

Infantile
spasms, also called West Syndrome, is a rare disorder that usually
begins in infants ages three to six months and stops by the age of two
to four. The spasms are a type of seizure associated with sudden
bending of the limbs or extension movements.

To
develop the guideline, the authors reviewed all of the scientific
studies on the topic. Guideline co-author Dr Mark Mackay, of the Royal Children's Hospital in Victoria, said:

'We
wanted to develop this guideline because surveys of paediatric
neurologists in the United States, Japan and the United Kingdom found
very different approaches to treatment. We wanted to see if the
scientific evidence could give us some answers as to the best practices
in the treatment of infantile spasms.

The
guideline determined that adrenocorticotropic hormone (ACTH) is
probably effective for the short-term treatment of infantile spasms.
However, the guideline states that there is not enough evidence
available to recommend the optimum dosage and length of treatment.
There is also insufficient evidence to determine whether oral
corticosteroids are an effective treatment for infantile spasms.

The
drug vigabatrin is possibly effective for the short-term treatment of
infantile spasms and is possibly also effective for children with
tuberous sclerosis, according to the guideline. The evidence suggests
that vision of children taking vigabatrin should be tested regularly,
as the drug can affect the retina.

The guideline determined that there is insufficient evidence to recommend other treatments for infantile spasms.

Dr Mackay said:

'This
guideline will be helpful for parents because many parents are
understandably concerned about the potentially serious side effects of
ACTH and vigabatrin. Even though there are other anticonvulsant drugs
that have less serious side effects, a careful review of the medical
literature suggests that ACTH and vigabatrin offer the best chance of
seizure control and reversal of the developmental regression that is
often associated with this severe form of epilepsy.'