Overview of Treatment in Infantile Spasms

Infantile Spasms is a rare disorder consisting of epileptic spasms that occur before the age of one year. This severe epilepsy affects about 0.31 in 1000 births with an average age at onset of 6 months. Treatment usually consists of hormonal therapies (adrenocorticotropic hormone or corticosteroids) or vigabatrin. Decisions about choice of therapy are complicated because these first-line treatments can have significant side effects, are often expensive, and there are few randomized, controlled, blinded studies to guide therapy. Hormonal therapies are the most common first-line treatments and multiple trials suggest that they are the most effective. Vigabatrin may be more effective in treating infantile spasms in patients with tuberous sclerosis. Studies evaluating long-term cognitive outcomes in patients with infantile spasms have failed to show that any therapy produces superior long-term cognitive outcomes in all types of patients. However, there are some data suggesting that early treatment with hormonal therapies improves outcomes in patients for whom a cause of infantile spasms is never found. In this article, we review the evidence for available treatments for infantile spasms.