RESOLUTION OF CLINICAL AND ELECTROENCEPHALOGRAPHIC CRYPTOGENIC INFANTILE SPASMS FOLLOWING TREATMENT WITH INTRAVENOUS METHYLPREDNISOLONE – AN EXPERIENCE WITH 3 CASES

Objectives: Adrenocorticotrophin (ACTH) and Vigabatrin are the treatment of choice for infantile spasms and are not readily available in Malaysia. Less often, corticosteroids such as prenisolone have been used, but the use of Methylprednisolone has not been well documented. We assessed the viability of intravenous methylprednisolone to treat infantile spasms.

Methods: Three case series of infants with cryptogenic infantile spasms seen in our centre from January 2004-August 2005 are described from the time of diagnosis.

Results: All 3 patients were male infants who had onset of infantile spasms and developmental regression following the onset of spasms between 4–5 months of age. Video-EEG confirmed electro-clinical spasms and interictal hypsarrhythmias in all 3 patients. Brain MRI and metabolic work-out were normal. No definite aetiology was identified. All of them had initially received other anti-epileptic medications for on-going spasms between 2–6 months duration, with unsatisfactory response. Intravenous Methylprednisolone was then started at a dosage of 30mg/kg/day in three divided doses for 3 days, followed by oral prednisolone at 2mg/kg/day for 2 weeks. Oral Prednisolone was then very gradually tapered off over several weeks. Clinical spasms ceased within 3 days and resolution of hypsarrhythmias was seen on repeat EEGs within 2 weeks of initiating treatment. There were no significant adverse effects noted during this regime. On follow-up, these 3 patients still continue to remain seizure free for 3 months up to 1 year 10 months. Improvements in developmental milestones were achieved after cessation of spasms, although varying degrees of developmental delay were noted.

Conclusion: Our experience shows that intravenous methylprednisolone seems to be an effective option of treatment in cryptogenic infantile spasms, especially if ready access to ACTH and Vigabatrin is restricted. However, its efficacy and safety needs to be measured against ACTH and oral prednisolone in larger prospective studies.