Dataset Information

Infantile spasms: Etiology, lead time and treatment response in a resource limited setting.

ABSTRACT: This study explores the etiology and lead time to treatment for infantile spasm (IS) patients and their effect on treatment responsiveness, in a limited resource setting. Patients with IS onset age ?12 months', seen over 3 years were recruited retrospectively. Clinical information, neuroimaging and genetic results retrieved. Patients categorized into three primary etiological groups: Structural (including Structural Genetic), Genetic, and Unknown. The effect of etiology and lead time from IS onset to initiating appropriate treatment on spasm resolution, evaluated. Total 113 patients were eligible. Mean IS onset age was 6.86(±4.25) months (M: F 3.3:1). Patients were grouped into: Structural 85, Genetic 11 and Unknown 17. Etiology was ascertained in 94/113 (83.1%) with neonatal hypoglycemic brain injury (NHBI) being the most common (40/113, 36%). A genetic etiology identified in 17 (including 6 Structural Genetic, of which five had Tuberous Sclerosis). Structural group was less likely to be treatment resistant (p = 0.013, OR 0.30 [0.12-0.76]). Median treatment lead time - 60 days. Longer lead time to treatment was significantly associated with resistant spasms (?2 for trend = 10.0, p = 0.0015). NHBI was the commonest underlying cause of IS. There was significant time lag to initiating appropriate treatment, affecting treatment responsiveness.

SUBMITTER: Surana P

PROVIDER: S-EPMC7656466 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Infantile spasms: Etiology, lead time and treatment response in a resource limited setting.

Surana Priyanka P Symonds Joseph D JD Srivastava Prabhar P Geetha Thenral S TS Jain Romit R Vedant Ramprasad R Murugan Sakthivel S Mahalingam Subathra S Bhargava Vivek V Goyal Pradeep P Zuberi Sameer M SM Jain Vivek V

Epilepsy & behavior reports 20201017

This study explores the etiology and lead time to treatment for infantile spasm (IS) patients and their effect on treatment responsiveness, in a limited resource setting. Patients with IS onset age ≤12 months', seen over 3 years were recruited retrospectively. Clinical information, neuroimaging and genetic results retrieved. Patients categorized into three primary etiological groups: Structural (including Structural Genetic), Genetic, and Unknown. The effect of etiology and lead time from IS ons ...[more]

PMID: 33196034

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Project description:ObjectiveEtiological classification of infantile spasms syndrome (ISS) is important, considering the influence on prognosis based on the presence or absence of a known etiology. This study was performed to describe the limitations and difficulties experienced within the South Asian region when classifying the etiology of ISS according to the current recommendation.MethodData on healthcare indices and facilities related to management of ISS for the nine countries in the South Asian region were gathered by the South Asian West Syndrome Research Group. A Google survey was performed among three hundred and thirty pediatric neurologists in the region. The capacity within each country for investigating etiology of ISS according to current described benchmarks was evaluated. The difficulties experienced in this regard and the potential solutions were investigated.ResultsOne hundred and sixty pediatric neurologists (response rate 48%) from Bangladesh (19/25), India (94/255), Myanmar (11/11), Nepal (6/8), Pakistan (19/25), and from Sri Lanka (7/8) responded. Three countries had no pediatric neurology services. Fifty-six percent attempted to classify ISS etiology according to classification outlined by International League Against Epilepsy in 2017. The facilities to perform metabolic, genetic, and immunological investigations were very limited. Lack of funding for investigations and poor laboratory support were the two most frequent barriers encountered. Sixty percent indicated that a separate classification is suitable for low-income setting; 78% suggested inclusion of separate category as "incompletely investigated" as an alternative solution to mitigate the barrier of achieving a better understanding of the etiological subtypes seen more frequently in this region.SignificanceThe resources in South Asian region are limited to meet the recommendations for investigating etiology of ISS. Including the etiological subcategory "incompletely investigated" is proposed as an alternative to understand the true proportions of children in this region, with a definite known etiology and those with an unknown etiology.

Dataset Information

Infantile spasms: Etiology, lead time and treatment response in a resource limited setting.

Publications

Infantile spasms: Etiology, lead time and treatment response in a resource limited setting.

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