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Bashiri FA, Hundallah K, Al-Baradie R, Al-Otaibi A, Ismayl O, AlMalik ME, Muthaffar OY, Futaisi AA, Kurdi D, Tawari AA, AlSowat D, Shafi SA, Ali A, AlHajjar LM, Aldakhil A. Diagnosis and management of infantile epileptic spasms syndrome (IESS) in Gulf Cooperation Council (GCC) countries: Expert consensus statement. Seizure 2024; 117:174-182. [PMID: 38432081 DOI: 10.1016/j.seizure.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
Despite the availability of international recommendations for the management of Infantile Epileptic Spasms Syndrome (IESS), there is a lack of recommendations adapted to the local context of clinical practice of pediatric neurology in the Gulf Cooperation Council (GCC) countries. By an initiative from the Saudi Pediatric Neurology Society (SPNS), a literature review was performed and an expert panel comprised of 13 pediatric neurologists from all GCC countries (Saudi Arabia, Kuwait, Bahrain, Oman, Qatar, and the United Arab Emirates) was subsequently convened to discuss all issues related to the management and diagnosis practices of IESS in the GCC. The overall aim of this consensus document was to develop practical recommendations to support the care of patients with IESS in the GCC and to reflect on how clinical management approaches compare with those adopted internationally.
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Affiliation(s)
- Fahad A Bashiri
- Pediatric Neurology Division, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Khalid Hundallah
- Pediatric Neurology Division, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh 13317, Saudi Arabia.
| | - Raidah Al-Baradie
- Neuroscience Center, King Fahd Specialist Hospital, PO Box 15215, Dammam 314444, Kingdom of Saudi Arabia.
| | - Ali Al-Otaibi
- Pediatric Neurology Division, Department of Neurophysiology, National Neuroscience Institute, King Fahad Medical City, As Sulimaniyah, Riyadh 12231, Saudi Arabia.
| | - Omar Ismayl
- Department of Child Neurology, Sheikh Khalifah Medical City, Al Karamah Street, Abu Dhabi, United Arab Emirates.
| | - Mohamed Elhadi AlMalik
- Department of Pediatric Neurology, Mediclinic Al Jowhara Hospital, Al Ain City, United Arab Emirates.
| | - Osama Y Muthaffar
- Pediatric Neurology Division, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Amna Al Futaisi
- Pediatric Neurology Division, Child Health Department, College of Medicine and Health Sciences, Sultan Qaboos University, P.O.Box 35, P.C 123 Al Khoud, Sultanate of Oman.
| | - Daniah Kurdi
- Pediatric Neurology Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia.
| | - Asmaa Al Tawari
- Pediatric Neurology Division, Department of Pediatrics, Al Sabah Hospital, Ministry of Health, Sabah Health Region, Shuwaikh Industrial, State of Kuwait.
| | - Daad AlSowat
- Pediatric Neurology Division, Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia.
| | - Shatha Al Shafi
- Neurology Division, Epilepsy and EEG Fellowship Program, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh 13317, Saudi Arabia.
| | - Ayman Ali
- Pediatric Neurology Division, Department of Pediatrics, AlSalam Specialist Hospital, Riffa 80278, Bahrain.
| | - Lynn M AlHajjar
- Itkan Health Consulting Group, Al Olaya, Riyadh 12221, Saudi Arabia.
| | - Abdullah Aldakhil
- Itkan Health Consulting Group, Al Olaya, Riyadh 12221, Saudi Arabia.
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Sharawat IK, Ramachandran A, Elwadhi A, Tomar A, Panda PK. Nutritional vitamin B12 deficiency-associated Infantile epileptic spasms syndrome: Clinico-neurophysiological presentation, response to treatment, and neurodevelopmental outcome. Seizure 2023; 110:93-98. [PMID: 37331199 DOI: 10.1016/j.seizure.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION Nutritional vitamin B12 deficiency has been shown to cause Infantile epileptic spasms syndrome (IESS) in infants in anecdotal studies. METHODS In this retrospective cohort study, we intended to study the clinical presentation, neurophysiological, laboratory abnormalities, treatment, and neurodevelopmental outcome at 6-months in infants presenting with IESS secondary to nutritional vitamin B12 deficiency (NVBD) and to compare these variables from the rest of the infants with IESS without vitamin B12 deficiency. We included only spasm-free cases or those who showed at least a 50% reduction in spasm frequency on D7 after starting oral/parenteral vitamin B12. We used well-validated measurement tools like the Developmental Assessment Scale for Indian Infants (DASII), Child Feeding Index (CFI), Burden of amplitudes and epileptiform discharges (BASED) score, countable Hypsarrhythmia paroxysm index (cHPI), durational Hypsarrhythmia paroxysm index (dHPI), and Early childhood epilepsy severity scale (E-CHESS) score for documenting these variables. RESULTS Data from 162 infants with IESS (21 caused by NVBD) were included in our study. The NVBD group had more patients residing in the rural region, with lower socioeconomic status, vegetarian mothers and poor complementary feeding index (p<0.001 for all). The NVBD group also had less number of patients requiring antiseizure medications (ASMs) and hormonal therapy(p<0.001), remained seizure free at six months (p=0.008), lower number of clusters per day (p=0.02) and the number of spasms per clusters at presentation (p=0.03), lower BASED score (p=0.03) and cHPI, dHPI at presentation (p<0.001). All of them remained spasm-free, with normal electroencephalogram at 6-months. Development quotient at baseline, at 6-months, and improvement in development quotient between these two-time points were more in the vitamin B12 deficiency group (p<0.001). All of them had clinical features of pre-ITS (infantile tremor syndrome) or ITS and it was found to be the only independent predictor of NVBD in infants with IESS. Mothers of all these infants had low serum vitamin B12 levels (<200 pg/ml). CONCLUSIONS Nutritional vitamin B12 deficiency may cause IESS in infants. Hence, vitamin B12 deficiency needs to be ruled out in patients with IESS without any definite etiology.
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Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Aparna Ramachandran
- Department of Neurology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala 673009, India
| | - Aman Elwadhi
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Apurva Tomar
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
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SARİGECİLİ E, MAKHAROBLİDZE K, KÖMÜR M, OKUYAZ C. The evaluation of the neurocognitive development of the symptomatic West Syndrome patients. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1209083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: Our study was aimed to determine both demographic and clinical data of patients with symptomatic West Syndrome (WS) and to monitor their neurocognitive development with Bayley Scales of Infant and Toddler Development Screening Test, third edition (Bayley-III) test.
Materials and Methods: Fourteen symptomatic WS patients were included in our study. Clinical and demographic data, electroencephalogram (EEG) findings, treatment response, Bayley III developmental test results were recorded before starting the treatment (T0) and in the 12th months of the treatment (T1 and T12).
Results: Patients had a significant increase in Bayley-III test scores in all areas at the end of one year (p <0.05). As the patients' EEGs improved, a statistically significant increase was observed in Bayley-III test scores in all areas (p <0.05). However, when the correlation between seizure control and the Bayley-III test scores were evaluated, there was an improvement only in the language area (p< 0,05); but there was no statistically significant difference in other brain areas (p> 0.05).
Conclusion: It has been shown that the neurocognitive level gradually improves even in symptomatic type WS with effective treatment during the follow-up of the disease or with the improvement of the EEG findings and seizure control.
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Affiliation(s)
- Esra SARİGECİLİ
- Republic of Türkiye Ministry of Health University Adana City Training and Research Hospital, Pediatric Neurology
| | | | - Mustafa KÖMÜR
- Mersin University, Faculty of Medicine, Department of Pediatric Neurology
| | - Cengiz OKUYAZ
- Mersin University, Faculty of Medicine, Department of Pediatric Neurology
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Jain P, Sahu JK, Horn PS, Chau V, Go C, Mahood Q, Arya R. Treatment of children with infantile spasms: A network meta-analysis. Dev Med Child Neurol 2022; 64:1330-1343. [PMID: 35765990 DOI: 10.1111/dmcn.15330] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022]
Abstract
AIM We performed a systematic review and network meta-analysis (NMA) to obtain comparative effectiveness estimates and rankings of non-surgical interventions used to treat infantile spasms. METHOD All randomized controlled trials (RCTs) including children 2 months to 3 years of age with infantile spasms (with hypsarrhythmia or hypsarrhythmia variants on electroencephalography) receiving appropriate first-line medical treatment were included. Electroclinical and clinical remissions within 1 month of starting treatment were analyzed. RESULTS Twenty-two RCTs comparing first-line treatments for infantile spasms were reviewed; of these, 17 were included in the NMA. Both frequentist and Bayesian network rankings for electroclinical remission showed that high dose adrenocorticotropic hormone (ACTH), methylprednisolone, low dose ACTH and magnesium sulfate (MgSO4 ) combination, low dose ACTH, and high dose prednisolone were most likely to be the 'best' interventions, although these were not significantly different from each other. For clinical remission, low dose ACTH/MgSO4 combination, high dose ACTH (with/without vitamin B6 ), high dose prednisolone, and low dose ACTH were 'best'. INTERPRETATION Treatments including ACTH and high dose prednisolone are more effective in achieving electroclinical and clinical remissions for infantile spasms. WHAT THIS PAPER ADDS Adrenocorticotropic hormone and high dose prednisolone are more effective than other medications for infantile spasms. Symptomatic etiology decreases the likelihood of remission even after adjusting for treatment lag.
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Affiliation(s)
- Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jitendra K Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Vann Chau
- Neonatal Neurology Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cristina Go
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Quenby Mahood
- Hospital Library and Archives, Learning Institute, Toronto, ON, Canada
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Kalra V, Viswanathan V, Shah H. A Review of the Prevalence, Etiology, Diagnosis, and Management of Pediatric Epilepsies in India. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0042-1742689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractPediatric seizures are one of the most common neurological manifestations seen in pediatrics. Unravelling the etiology, timely and appropriate investigations followed by suitable therapies are essential for improving quality of life. During the pandemic, focused group discussions were conducted among 50 pediatric neurologists across five cities in India to gather insights on treatment practices in pediatric epilepsy and to optimize therapeutic strategies and alternative approaches for rational use of antiepileptic medications. These discussions were mainly aimed at reviewing current literature on prevalence, etiology, diagnosis, and management of epilepsy in children and subsequently rationalizing diagnostic and treatment approaches in routine clinical practice. Epileptic encephalopathies comprise of childhood epilepsy with progressive cerebral dysfunction. Genomics plays a vital role in identifying the underlying genetic associations, empowering precision therapy. Currently, the ketogenic diet has become a well-recognized modality for reducing severity of seizures. To overcome the high incidence of adverse effects due to older antiepileptic drugs, newer drugs are being developed to improve ease of use, diminish drug interactions, decrease adverse effects, and identify drugs with unique mechanisms of action. Common lacunae in practice include information gaps, educating parents, or caregivers about rational drug use and ensuring compliance to antiepileptic medications. This article discussed the consensus clinical viewpoint of expert clinicians, as well as insights on optimized treatment of pediatric epilepsies in both infancy and childhood. It also discusses aspects, like reducing drug burden, emerging therapies in the identification of the genetic basis of epilepsies, and targeted therapy alternatives, for pediatric populations in the Indian scenario.
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Affiliation(s)
- Veena Kalra
- Department of Pediatric Neurology, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Harshuti Shah
- Department of Pediatric Neurology, Rajvee Child Neuro and Ortho-Spine Hospital, Ahmedabad, India
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Choudhary PK, Chakrabarty B. Treatment of West Syndrome: From Clinical Efficacy to Cost-Effectiveness, the Juggernaut Rolls On. Indian J Pediatr 2022; 89:109-110. [PMID: 34837642 DOI: 10.1007/s12098-021-04037-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, AIIMS, New Delhi, 110029, India.
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Wanigasinghe J, Sahu JK, Madaan P, Fatema K, Linn K, Chand P, Poudel P, Hamed E, Mynak ML, Hassan S. Classifying etiology of infantile spasms syndrome in resource-limited settings: A study from the South Asian region. Epilepsia Open 2021; 6:736-747. [PMID: 34653320 PMCID: PMC8633471 DOI: 10.1002/epi4.12548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
Objective Etiological classification of infantile spasms syndrome (ISS) is important, considering the influence on prognosis based on the presence or absence of a known etiology. This study was performed to describe the limitations and difficulties experienced within the South Asian region when classifying the etiology of ISS according to the current recommendation. Method Data on healthcare indices and facilities related to management of ISS for the nine countries in the South Asian region were gathered by the South Asian West Syndrome Research Group. A Google survey was performed among three hundred and thirty pediatric neurologists in the region. The capacity within each country for investigating etiology of ISS according to current described benchmarks was evaluated. The difficulties experienced in this regard and the potential solutions were investigated. Results One hundred and sixty pediatric neurologists (response rate 48%) from Bangladesh (19/25), India (94/255), Myanmar (11/11), Nepal (6/8), Pakistan (19/25), and from Sri Lanka (7/8) responded. Three countries had no pediatric neurology services. Fifty‐six percent attempted to classify ISS etiology according to classification outlined by International League Against Epilepsy in 2017. The facilities to perform metabolic, genetic, and immunological investigations were very limited. Lack of funding for investigations and poor laboratory support were the two most frequent barriers encountered. Sixty percent indicated that a separate classification is suitable for low‐income setting; 78% suggested inclusion of separate category as “incompletely investigated” as an alternative solution to mitigate the barrier of achieving a better understanding of the etiological subtypes seen more frequently in this region. Significance The resources in South Asian region are limited to meet the recommendations for investigating etiology of ISS. Including the etiological subcategory “incompletely investigated” is proposed as an alternative to understand the true proportions of children in this region, with a definite known etiology and those with an unknown etiology.
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Affiliation(s)
| | - Jitendra Kumar Sahu
- Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyanka Madaan
- Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanij Fatema
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kyaw Linn
- Yangon Children Hospital, Yangon, Myanmar
| | | | | | - Esmatullah Hamed
- French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Mimi L Mynak
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Nepal
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