Patient's question:
My baby started experiencing diarrhea when she was two months old. At three and a half months, she had a series of head-raising and hand-raising movements. Her 24-hour EEG was abnormal, and the hospital diagnosed her with infantile spasms. She was prescribed Topiramate, but after more than twenty days of treatment with no significant improvement (during which she was also treated for diarrhea with other medications), we decided to stop the medication. Two days later, she received an injection of vitamin B6. Over the next two days, her symptoms reduced to none, and her diarrhea also improved. A follow-up 24-hour EEG was normal. She hasn’t had any further episodes for two months now. She is now six months old, can roll over, loves hide-and-seek, giggles, takes steps with support, and has strong legs.Doctor's answer:
Thank you.The child started experiencing diarrhea at 2 months of age. Could you please tell me if the diarrhea is severe? How many times a day does it occur, and how much is each episode? The child has seen a doctor, and the doctor considered what factors might have caused the diarrhea. Severe diarrhea can lead to dehydration, resulting in an imbalance of water and electrolytes, which may cause convulsions. However, with the treatment of diarrhea and fluid supplementation, such convulsions can be controlled relatively quickly, and electroencephalograms (EEGs) are often normal.
First, it’s important to understand the diagnostic criteria for infantile spasms, which include three key elements: clinical typical episodic manifestations (nodding-like spasms), high-amplitude irregular patterns on EEG, and clinical evidence of intellectual developmental delay. The child exhibits nodding-like spasms, and the 24-hour EEG is abnormal (though I don’t know the specific EEG findings, such as whether there were high-amplitude irregular patterns?). However, you haven’t described the child’s clinical developmental status (e.g., motor development, intellectual development, especially intellectual development). Therefore, whether the child is diagnosed with infantile spasms is questionable, and the fact that antiepileptic medication has not been effective for over 20 days makes the diagnosis even more questionable. Have a head MRI been performed? Are there any family members with epilepsy?
Generally, the overall prognosis for infantile spasms is not very good, and the treatment can be challenging. Your child has not been treated with antiepileptic medication, but has been stabilized with treatments like vitamin B6 without further episodes, and their current developmental status is excellent. From the perspective of efficacy and prognosis, it is necessary to question whether the previous diagnosis was accurate, right?
I recommend taking your child to see a pediatric neurology doctor for a head MRI, EEG reevaluation, intelligence testing, and screening for hereditary metabolic diseases. Discuss the above issues with the doctor in person to hear their analysis and advice.
My views and opinions above are for your reference only.