| 1 Objective;To investigate the relationship between the clinical features and the prognosis of Infantile spasms(IS).2 Methods;This is a retrospective cohort study.From Jun.1994 to Dec.2004,the medical records of patients with IS in Departmant of Pediatrics,Qilu Hospital of Shandong University and in Qilu children's Hospital of Shandong University were analyzed,and all the patients were followed up more than two years.The predictors of prognosis of infantile spasms were analyzed.3 Results;(l)A total of 112 patients who were enrolled in this study including 72 boys and 40 girls.The mean age of seizures onset was 3.8 months(range=2～12 months).The mean duration of follow-up from onset of seizures was 58 months(range=24～120 months).The underlying causes were determined in 67.0% of patients.Among various etiological factors added to the long list of causes of West syndrome,focal cortical dysplasia or abnormity preterm infants or low-birth weight infants and Hypoxic-ischemic encephalopathy are the main etiological factors.There were 33.0% of patients with cryptogenic factors.The EEG appearences types were typical hypsarrithmia—52 patients(46.4%),different variants of modified hypsarrithmia—57 patients(50.9%), presences of focal epileptiform discharges—3 patients(2.7%). (2)42(37.5%)patients were seizure-free,persistent in the same form only in two and persisting but changes to another form in the rest.Factors influencing seizure outcome were etiologies and treatment lag.The patients with shorter treatment lag(≤2 months) and initial effects were better on seizure than those with longer treatment lag(>2 months)and with the indetified effects.Seizure outcome had not correlated with the age of onset.(3)Mental outcome was also mainly effected by initial effects and treatment lag.(4)The next pattern after hypsarrhythmia were often focal or extensive epileptiform discharges.focal discharges was spike and wave complexes on the occipital or temporal areas or bilateral.The typical hypsarrithmia usually correlated with a better outcome compared with modified hypsarrithmia.Nine(8.9%)children died in this group.4 Conlusion;Infantile spasms were mostly effected by symptomatic factors.In this study,the risk factors that correlate with the proganosis of IS may include the etiology,treatment lag less than 2 months and the modified hypsarrithmia of EEG apperances. 1 Objective;To evaluate the efficacy and tolerability of first-line topiramate treantment for infantile spasms.2 Methods;26 patients with infantile spasms received topiramate monotherapy in this study.This patients were all newly diagnosed in the Department of Pediatrics of Qilu Hospital of Shandong University during Jun,2003～Dec,2004.They were treated with an initial dose of 1 mg/kg.d,with a progressive titration of 1mg/kg.d a week until their spasms were controlled and maximum dose of 12mg/kg.d was achieved.The evaluation of the treatment efficacy was based on the spasms frequency date that was obtained by the scalp and Video-EEG,and by the parental count of spasms.3 Results;The etiology of the infantile spasms included a cryptogenic group(n=17)and a sympromatric group(n=9). Overall,30.8% of the subjects became spasm-free during the study.Eight of 20 subjects(30.8%)had cessation of spasms and disapprearance of hypsarrhythmia as seen Via the Video-EEG; Five(55.5%)of nine cryptogenic patients had a response, whereas three(17.6%)of 17 patiens with symptomatric infantile spasms responded.Eighteen patients(69.3%), including the spasms-free patients,had a reduction in their seizure frequency of more than 50%,and 11.5% of the patients had a reduction in their seizure frequency of less than 50%.The clusters of spasms frequency decreased from 10.6±8.5 to 3.5±1.4 c 1 u t er s/day.4 Conclusion;Topiramate is effective and tolerated in those patients suffering from infantile spasms.Our results suggest that this drug should be considered as a new first-line drug for treating infantile spasms. |
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