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Response to second treatment after initial failed treatment in a multicenter prospective infantile spasms cohort
Author(s) -
Knupp Kelly G.,
Leister Erin,
Coryell Jason,
Nickels Katherine C.,
Ryan Nicole,
JuarezColunga Elizabeth,
Gaillard William D.,
Mytinger John R.,
Berg Anne T.,
Millichap John,
Nordli Douglas R.,
Joshi Sucheta,
Shellhaas Renée A.,
Loddenkemper Tobias,
Dlugos Dennis,
Wirrell Elaine,
Sullivan Joseph,
Hartman Adam L.,
Kossoff Eric H.,
Grinspan Zachary M.,
Hamikawa Lorie
Publication year - 2016
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13557
Subject(s) - vigabatrin , medicine , pediatrics , prospective cohort study , adrenocorticotropic hormone , cohort , logistic regression , epilepsy , anticonvulsant , hormone , psychiatry
Summary Objective Infantile spasms ( IS ) represent a severe epileptic encephalopathy presenting in the first 2 years of life. Recommended first‐line therapies (hormonal therapy or vigabatrin) often fail. We evaluated response to second treatment for IS in children in whom the initial therapy failed to produce both clinical remission and electrographic resolution of hypsarhythmia and whether time to treatment was related to outcome. Methods The National Infantile Spasms Consortium established a multicenter, prospective database enrolling infants with new diagnosis of IS. Children were considered nonresponders to first treatment if there was no clinical remission or persistence of hypsarhythmia. Treatment was evaluated as hormonal therapy (adrenocorticotropic hormone [ ACTH ] or oral corticosteroids), vigabatrin, or “other.” Standard treatments (hormonal and vigabatrin) were compared to all other nonstandard treatments. We compared response rates using chi‐square tests and multivariable logistic regression models. Results One hundred eighteen infants were included from 19 centers. Overall response rate to a second treatment was 37% (n = 44). Children who received standard medications with differing mechanisms for first and second treatment had higher response rates than other sequences (27/49 [55%] vs. 17/69 [25%], p < 0.001). Children receiving first treatment within 4 weeks of IS onset had a higher response rate to second treatment than those initially treated later (36/82 [44%] vs. 8/34 [24%], p = 0.040). Significance Greater than one third of children with IS will respond to a second medication. Choosing a standard medication ( ACTH , oral corticosteroids, or vigabatrin) that has a different mechanism of action appears to be more effective. Rapid initial treatment increases the likelihood of response to the second treatment.