Infantile Spasms

Introduction

Infantile spasms are a special form of epilepsy which occurs during infancy. The spasms usually begin when the baby is between three and eight months of age. In approximately 50 per cent of cases, the cause of infantile spasms is not known. However, in the other 50 per cent there are many different conditions affecting the brain, such as birth malformation, birth injury and meningitis, which can cause this type of epilepsy.

Diagnosis

The diagnosis of infantile spasms is difficult and requires careful observation of the child. Characteristic signs include a combination of the spasms, developmental delay and a characteristic disorganised EEG (electroencephalogram - a written record of the brain's electrical activity) pattern called hypsarrhythmia. This EEG pattern is seen in about 70 to 80 per cent of children with this condition.

The spasms

Symptoms can vary from child to child, however there is usually a sudden spasm or bending (flexion) of the body either at the waist or neck. A baby who is not yet sitting up may be lying quite comfortably and will suddenly draw the legs up at the hips, throw the arms out and lift the head. It is not uncommon for the baby to cry out after a spasm and be rather irritable.

Children who can sit may bend at the waist and their head can fall forward.

Spasms usually occur in clusters. Each one is brief, lasting only a few seconds. Seizures may occur more often when the child is drowsy, either just going off to sleep or just having woken.

Prognosis

This form of epilepsy is caused by a variety of conditions, each with different outlooks.

When a child's development has been normal prior to the onset of the spasms, there is a better chance of: a) controlling the seizures with medication; and b) development and learning being normal or only mildly delayed.

However, when infantile spasms are associated with structural damage to the brain, it is difficult to completely control the seizures and intellectual disability is very likely to be present.

In most babies the spasms will cease between the ages of two to four. Approximately half the children will continue to have other kinds of seizures when the infantile spasms have stopped.

Treatment

Infantile spasms often respond to Prednisolone or A.C.T.H. (cortisone-like medications) or Vigabatrin. To avoid long term use of these drugs, Nitrazepam (Mogadon) and Clonazepam (Rivotril) are often used in conjunction with the A.C.T.H., Prednisolone and Epilim.