| Objective:To search the theoretical basis through studying the effects of polytherapy on spasm seizures, ambulatory EEG, serum NSE and the psychomotor development and analyzing the influential factors of the treatmental effects and their prognosis in children with newly diagnosed infantile spasm, ambulatory EEG, serum NSE and the psychomotor development.Methods:108 cases with newly diagnosed infantile spasm were gathered from September 2007 to November in the department of pediatric neurology, hematology and rehabilitation of the first hospital of Jilin University. The data of gender, onset age, etiology, disease course, psychomotor development,24-hour ambulatory EEG, brain image changes and seizure frenquency after treatment, serum levels of neuron-specific enolase, EEG changes were retrospectively analyzed and the follow-up was carried out at outpatient clinic, and the dynamic psychomotor changes of 21 cases with seizure free were monitored at the time points of admission,1 month and 6 months after spasm free, respectively.Results:1. Of 108 cases with newly diagnosed infantile spasm, male to female ratio was 2.34:1 (76 males and 32 females); 82 (75.9%)cases were symptomatic, and 26 (24.1%) cases were cryptogenic; disease duration in 70 cases (64.8%) was less than 2 months, and disease duration in 38 patients (35.2%) was≥2 months; the earliest onset age was 1 month, whereas the oldest onset age was 4 years, and onset age of 83 cases (77.2%) was between 3 months and 1 year old; Seizure pattern was divided into flexion (73 cases), extension (18 cases) and mixed (17 cases), and the proportion was 67.6%,16.7% and 15.7%, respectively; at the time point of admission,84 patients (77.8%) showed psychomotor development delay, and 24 cases (22.2%) were normal psychomotor development.2. Of the 108 cases of infantile spasms in this study,82 cases were symptomatic,26 cases were cryptogenic. In this study,53 cases had abnormal personal history. Intrauterine hypoxia, intrapartum asphyxia, congenital malformation or intracranial hemorrhage were the main reason. All cases were examined by brain CT or MRI imaging including 25 cases with CT and 87 cases with MRI. Brain images of 35 cases were normal, while 73 cases showed abnormalities.16 cases was abnormal in CT, while 57 patients abnormal in MRI. After treatment, there were Brain images in 10 cases without complete cessation abnormal.3. Of 108 cases in this study,90 patients were seizure free,8 cases were effective, and 10 cases were ineffective, so the complete control rate was 83.3%, and the total effective rate was 90.7%. The rapidestly effective time point was 1 day, whereas the longest effective time point was 25 days, and 93 cases showed effective within 2 weeks. Of 90 patients with seizure cessation, the rapidest seizure free time was 3 days, whereas the longest sezure free time was 57 days,71 cases (78.9%) reached seizure free within 2 weeks and other 19 cases got seizure free 2 weeks later.68 (82.9%) cases were seizure free in the symptomatic patients and 22 cases were seizure free in the cryptogenic patients.4. Changes of 24-hour ambulatory EEG included the typical hypsarrhyt-hmia and the variant hypsarrhythmia. Typical hypsarrhythmia was found in 48 cases (44.4%), and the variant hypsarrhythmia was found in 60 cases (55.6%). AEEGs were reexamined in 90 patients within one week since seizure free, and the datas showed that AEEGs were normalized in 56 cases (62.2%), sporadic sharp and slow waves without hypsarrythmia in 32 cases(35.6%), and hypsarrythmia was found in 2 cases (2.2%), and the total effective rate was 7.8%.5. Serum NSE in 35 cases with seizure free were examined at the time points such as hospital admission,48 hours and one month after seizure cessation, respectively. NSE level was significantly decreased at 48 hours since seizure free than that of admission time point, P<0.05; and NSE at one month since seizure free was furtherly lowered when compared with that at admission point, P<0.01.6. Twenty one patients were followed up with Gesell development schedules at the time points such as hospital admission and one month after seizure cessation complete control of seizures, showed no statistically significant determination, but the development of Gesell development schedules test results show higher than before treatment. Gesell development schedules test in 6 months after seizure cessation complete control of seizures show that P<0.05, compared with the results before treatment, showed statistically significant.7. Multiple factors such as gender, etiology, age of onset, duration, a intellectual development, EEG, and brain image changes which might influence the seizure control were analyzed, and results showed that brain image, EEG and clinical course prior treatment were definitely related to the effects of seizure control.8. All patients were followed up for 5 months to 3 years and no one died during the time. Of 7 cases (7.8%) who relapsed,5 cases were symptomatic and 2 cases were cryptogenic. Relapse times were 2 to 23 months since seizure free, and 3 cases got seizure free again for ACTH readministration, one cased evovled to LGS. the other 3 cases gave up further treatment. There was no significant difference in 21 cases with seizure free on the intelligence test at the time points between admission and one month since seizure free. Intelligence was significantly improved 6 months since seizure free when compared with admission.9. Blood and urine routine tests, blood plasma inions and hepatic and renal function were tested regularly during the polytherapy. Minority of the cases developed mild respiratory tract infection, electrolyte disturbances (mainly low potassium), irritability, hypohydrosis, fever, lethargy, mental sluggish, blood hypertension, diarrhea, etc., and all the cases were cured by symptomatic treatment, no severe adverse effects and heptic and renal dysfunction were found. No severe adverse effects were found during the following up.Conclusion:1. Effective and seizure rates in infantile spasms cases treated with polytherpy are relatively higher, and the time to seizure free in symptomatic in symptomatic is longer than that in the cryptogenic cases.2. Polytherapy for infantile spasm can ameliorate the abnormal EEGs, NSE level is decreased after seizure cessation, intelligence is improved 6 months since seizure free and the prognosis may be improved with polytherapy in children with infantile spasm.3. Refractory Spasms are related to disease course longer than or equal to 2 months prior treatment, atypical hypsarrhythemia. |
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