What is the Best Treatment for Infantile Spasms?

Infantile Spasms Treatment: ACTH, Vigabatrin and More

Infantile spasms, or epileptic spasms, are a rare and serious type of epilepsy that usually occurs in infants less than 12 months of age. They consist of sudden, brief tensing or jerking of the body-frequently the head, arms, legs, and trunk—and usually occur in clusters, particularly after awakening from sleep.

Since late treatment can lead to irreversible developmental damage, infantile spasms should be diagnosed and treated as early as possible. For that, it is crucial to know the infantile spasms treatment options, top medications and potential side effects.

Keep reading!

How to Treat Infantile Spasms?

Treating infantile spasms effectively is essential to stopping seizures, enhancing brain function, and avoiding long-term developmental damage. The following are the most effective treatments for this condition:

• Adrenocorticotropic Hormone (ACTH) : ACTH is among the most frequently used first-line medications for infantile spasms. It is an injection of a man-made hormone that promotes the body's reaction to stress by stimulating the adrenal glands to release cortisol. 
  The treatment is typically initiated in the hospital so that the physicians can monitor the infant closely for any side effects. If tolerated well, the therapy lasts for approximately six weeks, and the parents are instructed on how to administer the injections at home.
• Oral Prednisolone : Prednisolone is a corticosteroid taken orally and employed as a substitute for ACTH, particularly if ACTH is unavailable, prohibitively expensive, or not suitable for the child. It operates in the same manner by decreasing inflammation and aberrant electrical activity in the brain.
  It is less challenging to administer than ACTH and has proven similarly effective in most situations. Physicians monitor for side effects like enhanced appetite, mood changes, and a compromised immune system and usually treat for several weeks with close EEG observation.
• Vigabatrin (Sabril) : Vigabatrin is a second-line treatment for infantile spasms and can be very effective when the spasms are due to a genetic disorder known as tuberous sclerosis complex (TSC). It is an oral anti-seizure medication that comes in the form of a pill or liquid.
  Although generally tolerated, one significant risk is loss of vision, so eye check-ups are necessary. This drug can be extremely effective, with spasms frequently stopping and EEG returning to normal in a few weeks.
• Ketogenic Diet : If vigabatrin or hormonal treatments fail, the ketogenic diet is another option. It's a low-carbohydrate, high-fat diet that alters the way the body uses energy and has been found to lower seizures in certain children. 
  The diet needs to be well-planned and monitored by an expert team to provide adequate nutrition and prevent side effects. While not typically the initial treatment option, it can be a valuable choice for children who have drug-resistant infantile spasms.
• Other Anti-Seizure Medicines : If initial treatments are ineffective, physicians can try other antiepileptic drugs. Such medicines are typically selected based on the child's personal medical history and response to previous treatments. They might also be combined with other treatments to control symptoms.
• Epilepsy Surgery : In a few children, infantile spasms may occur due to a particular brain lesion that can be visualised in imaging studies. For them, the spasms cannot be controlled with medication, and epilepsy surgery may be an option.
  The procedures involved are lesion resection or even more radical procedures, such as hemispherectomy, based on where the abnormality is located. If it works, surgery can halt spasms and advance long-term development, but it's usually reserved for challenging or critical cases.
• Treating the Underlying Cause : If physicians can diagnose the root cause of the spasms—like a metabolic disorder, a hereditary condition, or a brain anomaly-treatment needs to address that condition as well. This may involve certain medical therapies, dietary management, or even surgery.

What are the top medications prescribed for infantile spasms?

Here is a list of some frequently prescribed medications aimed at treating or alleviating the symptoms of infantile spasms:

1. Actest 80 unit/ml Injection Gel
2. Acthar 80 unit/ml Injection Gel Corticotropins
3. Corticotropin 40 unit/0.5 ml Subcutaneous Pen Injector
4. Sabril 500 mg Oral Powder Packet
5. Vigadrone 500 mg Oral Powder Packet
6. Vigafyde 100 mg/ml Oral Solution Anticonvulsant - GABA Modulators
7. Acthar Selfject 40 unit/0.5 ml Subcutaneous Pen Injector Corticotropins

What are the potential side effects of infantile spasms treatment?

The major side effects of adrenocorticotropic hormone (ACTH) therapy for infantile spasms may include:

• High blood pressure (hypertension)
• Swelling, particularly in the facial area
• Compromised immune system (immunosuppression)
• Gastric ulcers and/or intestinal ulcers
• Increased fear and anxiety
• Excretion of glucose in urine
• Permanent narrowing of the visual field
• Increased irritability

Infantile spasms are a severe neurological crisis in infancy. Although the condition is terrifying and overwhelming for families, early diagnosis and proper treatment can improve a child's prospects of improved developmental progress.

Doctors need to respond promptly if infantile spasms are suspected. Prompt recognition, rapid diagnosis with EEG, and quick treatment can make a huge difference.