Wednesday, November 23, 2005

Infantile Spasms, What is it?

What should I know about Infantile Spasms
Infantile Spasms are often initially mistaken for other conditions. However, prompt diagnosis and appropriate treatment of infantile spasms are critical. Soon after the spasms begin, children may stop making development progress or even lose skills they had previously aquired. Swift and effective treatment may provide the best development outcome possible.
The exact number of children who suffer from Infantile Spasms is not known, but it has been estimated that it affects 1 out of every 2 or 3 thousand babies. Infantile Spasms usually begins between 1 and 12 months of age and usually goes away on their own, even if left untreated, by the age of 2 to 4 years old.
Diagnosis is extablished on the basis of clinical manifestations, although the characteristic EEG finding of hypsarrhythmia is found in up to 80% of cases. Hypsarrhythmia consists of a unique, chaotic pattern of asynchronous, high amplitude slow waves and spikes which is peculiar to this disorder.
The spasms really are spasms of the muscles that affect a child's head, body, arms, and legs. The spasms commonly occur in clusters (grouped together). These movements may be small and barely noticeable, like twitches, or be large movements of the arms, legs, and body, followed by stiffening of those parts. Infants may have dozens of clusters and several hundred spasms per day. The intensity and/or the number of the spasms may increase, decrease, or stop altogether over time. The spasms tend to occur when the baby is tired, usually just after waking up or just before going to sleep. They rarely occur during sleep.
What Causes Infantile Spasms?
Doctors sometimes can find the cause of Infantile Spasms, and sometimes they can’t. Because of this, doctors have divided patients with Infantile Spasms into two groups.
The first group consists of patients in whom an underlying problem can be identified (also called the symptomatic group). The kinds of problems that can be found in this group are many. As was mentioned earlier, the most common cause is a lack of oxygen to the baby during delivery. Other causes include such things as mothers who had infections during pregnancy, mothers who had been exposed to certain chemicals during pregnancy, and babies who have abnormal brain development for other reasons.
The second group includes those patients in whom no specific underlying problem can be found (also called the cryptogenic group) after different medical tests (blood tests, spinal taps, CAT scans etc) are done looking for a cause.
It is important to divide the groups this way, because children in the first category (symptomatic) almost always have problems for the rest of their lives (epilepsy, cerebral palsy, mental retardation), while patients in the second category (cryptogenic) often make a complete recovery.
Is there any treatment for Infantile Spasms?
The two most common treatments are medicines called Prednisone and ACTH (abbreviation for Adrenocorticotropic Hormone). These are related to the extent that both have something to do with cortisone, a chemical normally made in the adrenal glands of the body. Prednisone is a pill form of cortisone. ACTH is a hormone normally made in the brain, but which can also be given as a medicine, to stimulate the adrenal glands to make extra cortisone.
Cortisone has been shown in many cases to stop the spasms. Most doctors think that controlling the spasms with early treatment with Prednisone and ACTH improves the chances of these patients developing normally.
Another medicine used to control Infantile Spasms is vigabatrin. It is currently not approved for sale in the United States because of some of its side effects

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