Friday, May 5, 2023

Infantile spasms: A frontline guide for pediatricians

Eric H Kossoff, Seva G. Khambadkone. Infantile spasms: A frontline guide for pediatricians
Contemporary PEDS JournalApril 2023

From the article

Home video recording as a clinical tool

Given the length of a typical clinic visit, it is unlikely that the infant will have a spasm in the office. This is where home video recordings (eg, via smartphones) can be extremely helpful. Home video recording, first advised by the Child Neurology Society to streamline IESS management at the onset of the COVID-19 pandemic, has since been endorsed as a continued recommendation toward timely intervention. In preparing to evaluate a patient with possible IESS, pediatricians should ask caregivers to record suspected events. Videos should be reviewed prior to the scheduled visit if possible and filed to share with consulting providers including child neurologists. Shortened clips can easily be shared through patient/provider portals in most electronic medical records, whereas longer videos may require secure cloud services...

Follow-up and prognosis

Unfortunately, even in some cases with spasm resolution, long-term prognosis is often poor. Outcomes include subsequent epilepsy and neurodevelopmental impairment. Etiology may be the most important predictor of outcome.23 Lead time to treatment is another critical and modifiable prognostic factor. Several studies to date have found improved developmental/intellectual outcomes with shorter delays between spasm onset and treatment, highlighting the importance of early intervention. In the UKISS study, this relationship was suggested to be dose dependent, where longer lead time durations were associated with a stepwise decline in developmental assessment scores at aged 4 years.

Children with history of IESS should be followed closely for developmental and neurological sequelae. Psychomotor development should be monitored until at least kindergarten, even in children who appear to have excellent prognoses. It is best to involve a developmental pediatrician in this care as well as to have a low bar for the recruitment of allied specialists including physical, occupational, and speech therapists. While outcomes can be challenging, close allyship among the family, primary pediatrician, neurologist, and broader care team will go far toward creating an environment of support and resilience.

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