How is infantile spasm (West syndrome) treated?

Updated: Jan 11, 2019
  • Author: Tracy A Glauser, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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The goals of treatment for infants with infantile spasms are the best quality of life (with no seizures), the fewest adverse effects from treatment, and the lowest number of medications.

Medications such as ACTH, oral corticosteroids, vigabatrin, and conventional antiepileptic drugs (AEDs) have all been used for infantile spasms. Unfortunately, no single medical treatment gives satisfactory relief for all infants with infantile spasms, and what is considered the best approach for treatment has been a debated and evolving topic.

In 2007, an expert survey concluded that 1-3 trials of monotherapy should be implemented before considering epilepsy surgery. In patients with tuberous sclerosis or symptomatic infantile spasms, vigabatrin was the drug of choice. [13, 14] Publications regarding specific treatments are reviewed in the Medication section, however, findings from a multicenter prospective database of infants with new diagnosis of infantile spasms compared "standard therapy" with ACTH, oral steroids, or vigabatrin to all other medications and found that 46% of patients treated with standard therapy had remission of spasms and resolution of hypsarrhythmia sustained at 3 months after initiation of the treatment, versus 9% of patients treated with "nonstandard" therapy. [15]

Focal cortical resection

In some patients, resection of a localized region can lead to freedom from seizures.

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