The patterns of response of 11 regimens for infantile spasms

Abstract

Infantile spasms (ISs) is a devastating form of an early infantile epileptic encephalopathy. The patterns of response of multiple regimens, and the difference in response rates for the cases who receive first-line therapies on time versus those who receive them after non-first-line therapies are unknown. We performed a study involving 314 ISs cases aiming to investigate the patterns of response of 11 regimens, and the difference in response rates for the cases received first-line therapies as first two regimens versus those who received other drugs prior to first-line options. As a result, the efficacy of each regimen was: the foremost two regimens; 36.99%, third; 10.27%, fourth; 6.16%, fifth; 5.48%, and from the sixth regimen onwards, each additional regimen added ≤ 2% probability of seizure freedom. There was a statistically significant difference in seizure freedom rates between cases received first-line therapies as first or second regimen versus those who received them later. Our study revealed for the first time that in ISs cases, seizure freedom is likely to be observed within the first five regimens, and an early administration of first-line therapies is superior to non-first-line options. These results will aid in management of ISs cases.

Different pharmacoresistance of focal epileptic spasms, generalized epileptic spasms, and generalized epileptic spasms combined with focal seizures

“…3 Furthermore, the proportions of patients achieving freedom from seizures after receiving the first, second, and third regimens were reported to be 15.1%, 21.9%, and 10.3%, respectively. 11 These data suggest that the drugs for the initial treatment are not necessarily selected appropriately. Application of precision medicine approach to the initial treatment is expected to improve seizure and cognitive outcomes.…”

Comparison of efficacy and safety of corticosteroids and vigabatrin plus corticosteroids in infantile spasm: An open label randomized control trial.

“…Normal cognitive findings were seen in 100% of patients treated with ACTH early (within 1 month), 67% of patients treated with ACTH later, and 54% of patients treated with vigabatrin (p = 0.03). 14 In contrast, for the study by Mohamed et al, 61% of individuals responded to prednisolone 40 mg/ day and 42% to vigabatrin. 15 The cryptogenic group responded much better to corticosteroids than the symptomatic group.…”

“…13 Similarly, the drug vigabatrin (100-180 mg/kg/ day) was administered to 14 newborns with idiopathic West syndrome (Class IV) and 14 children were treated with ACTH in a retrospective multicenter research (100 IU on alternate days). 14 Eighty percent of patients on vigabatrin stopped having spasms after 2 weeks, whereas 88% of patients taking ACTH did the same. Normal cognitive findings were seen in 100% of patients treated with ACTH early (within 1 month), 67% of patients treated with ACTH later, and 54% of patients treated with vigabatrin (p = 0.03).…”