ICNC Abstracts, ICNC 2018

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Nitrazepam as first line treatment for Infantile Spasm-20 years’ experience from Tertiary Paediatric Neurosciences Centre
Jay Shetty, Paul Eunson, Celia Brand, kenneth McWilliam, Krishnaraya Kamath Tallur, Richard Chin, Ailsa McLellan

Last modified: 2018-09-09

Abstract


Background: Infantile Spasms(IS) treatment varies throughout the world. Hormonal(ACTH/Prednisolone) and Vigabatrin have been shown to be beneficial for spasm cessation but may not influence long term developmental outcome. Current IS treatment has significant morbidity and even mortality, therefore requires monitoring is a challenge in resource poor countries.

Nitrazepam is an effective and safe treatment in IS1, 2.3 and has been the first line treatment in our centre for more than 20 years.

Methods: Cases of IS(1999-2018) were identified through EEG database and Clinical, investigation and treatment data were collected.


Results: 73 infants with IS(28 idiopathic; median age of onset 6 months). Time to diagnosis was 1 day- 4 months. 70 (M:F 38:32) of them received Nitrazepam as first line  and 38.5%  had complete resolution of spasms and normalisation of EEG. Infants who had an incomplete response to Nitrazepam were given ACTH, 11 infants were resistant to all treatment.

71% of idiopathic IS responded to Nitrazepam alone.  Seven infants with Down’s Syndrome(DS) and six responded to Nitrazepam alone. Nitrazepam was well tolerated without any significant side effects. The median dose was 0.6 mg/kg/day and the median response was 9 days (1-17 days). One death occurred on ACTH treatment. We are currently comparing response to treatment and developmental outcome with centres who use standard treatment.

Conclusions: Nitrazepam is safe and effective first line treatment in IS particularly in idiopathic & DS group, and is cost effective which may be highly beneficial in resource poor settings.

Keywords


Infantile Spasms; Nitrazepam; West Syndrome

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