Can children with infantile spasms survive?

Patient's question:

Patient Age: 1 year
Main Symptoms: Spasms, Epilepsy
Onset Time: 09/04/23
Laboratory Test Results: Spasms

Doctor's answer:

Hello: Infantile spasms are also a type of refractory epilepsy syndrome, most commonly caused by brain organic lesions or genetic metabolic diseases. Conventional antiepileptic drugs are almost ineffective. Therefore, at present, clinical treatment can only focus on controlling recurrence on one hand and actively identifying and eliminating the cause on the other. In terms of drug treatment, there are the following methods:
① Corticosteroid therapy: Adrenocorticotropic hormone (ACTH) is currently considered the most effective and commonly used alone. The dose is 25–40 units daily, administered intramuscularly for 2–6 weeks. It shows significant short-term effects in controlling spasms and improving EEG, especially in primary cases. However, long-term effects are difficult to assess, and it may cause hypertension and hypokalemia. For patients who do not respond to ACTH, dexamethasone (0.3–0.5 mg/kg body weight/day) or prednisone (2–10 mg/kg body weight/day) can be used orally for 2–6 weeks. If spasms cease and EEG returns to normal, the dose can be gradually reduced by 0.5 mg of dexamethasone or 2.5 mg of prednisone per week until half the initial dose is reached, then maintained for 3 months, followed by a smaller dose for several months. During corticosteroid tapering, nitrazepam can be combined, and infection prevention and control, as well as appropriate potassium and sodium supplementation, should be noted.
② Sodium valproate: The initial dose is usually 15–20 mg/kg body weight/day, gradually increased to 60–70 mg/kg body weight/day, with some cases reaching up to 100 mg/kg body weight/day. If there are no toxic side effects, a slightly higher dose is more effective, but severe liver toxicity should be monitored.
③ Fenobarbital, oxcarbazepine: These two drugs are often used alone or as adjunctive therapy. Starting with a low dose, it is increased weekly until efficacy is achieved without significant side effects. Fenobarbital has an initial dose of 15 mg/kg body weight/day and a maintenance dose of 45 mg/kg body weight/day. Oxcarbazepine has a dose range of 40–100 mg/kg body weight/day.
④ Vitamin B6: The dose is 20–50 mg/kg body weight/day, taken 3–4 times orally, starting with a low dose and increasing by 1 dose every 3–4 days for 2 weeks. If combined with ACTH or sodium valproate, the effect is better. Side effects include decreased appetite, nausea, vomiting, diarrhea, and liver dysfunction.
⑤ Immunoglobulin: Currently, there is no uniform intravenous injection method or dose. Generally, it is given at 200 mg/kg body weight per dose, once every other day for 3 doses, repeated after 3 weeks. For intramuscular injection, low-temperature ethanol-treated human gamma globulin is used, with a course of 1000–1500 mg/kg body weight, administered 300–600 mg daily, with no significant side effects.
In terms of etiological treatment: If caused by intracranial space-occupying lesions, some patients may not have recurrence even without antiepileptic drug treatment after surgery. Some genetic metabolic diseases can also be controlled by supplementing large amounts of B vitamins. For infantile spasms with unclear or unresolved etiology, clinical treatment primarily focuses on controlling recurrence.
In summary, regardless of the specific case, early treatment and timely control of recurrence yield better outcomes, whereas delayed treatment can lead to poor or even very poor results. You should seek timely treatment for your child. If treated promptly, improvement is likely.