Abstract
Over the last several decades, significant progress has been made in the discovery
of appropriate therapy in the management of infantile spasms (IS). Based on several
well-controlled studies, the American Academy of Neurology and the Child Neurology
Society have published the current best practice parameters for the treatment of IS.
However, dissemination and implementation of evidence-based guidelines remain a significant
challenge. Though the number of well-performed controlled trials and systematic reviews
is increasing exponentially, the proportion of valuable new information subsequently
embedding into the routine clinical care is significantly lower. Planned and systematic
implementation of evidence-based interventions in a given health care structure may
outstrip the benefits of discovering a new insight, procedure, or drug in another
controlled setting. Implementation problems can be broad-ranging to hinder effective,
efficient, safe, timely, and patient-centered care without significant variation.
The first part of this review article provides a detailed summary of some crucial
comparative treatment studies of IS available in the literature. In the second part,
practical challenges to mitigate the gap between knowledge and practice to improve
outcomes in the management of IS has been explored, and a consolidated framework approach
for systematic implementation research methodology has been discussed to implement
evidence-based guidelines for the management of IS. Although large multicenter controlled
studies will help gather quality evidence in the treatment of IS, a more comprehensive
range of scientific methodologies, including qualitative research and mixed research
methodologies, will hold the more considerable promise for implementing evidence-based
practices in the health care system.
Keywords
implementation research - infantile spasms - epileptic spasms - guideline - ACTH -
steroid - vigabatrin - qualitative research
