Long‐term Prognosis after Infantile Spasms: a Statistical Study of Prognostic Factors in 200 Cases

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Abstract
A follow-up study was made on 200 children (115 boys, 85 girls) who had infantile spasms, to compare their present condition over the age of 6 yr with various prognostic factors. Of the children, 48 (30 males and 18 females) died, and all the rest were aged 6 yr or older at the time of final follow-up. Of the children, 139 received ACTH therapy; at final follow-up, spasms had ceased in 43.5%, and about the same proportion showed normal physical development; 23% had normal mental development and 15.4% were attending ordinary schools. Complete recovery (normal mental and physical development and attending ordinary schools) was achieved in only 19 cases (9.5%). Of the cryptogenic cases, 44.4% had made a full recovery. The poor prognostic factors for continuing seizures were: evolution into other types of fits, relapse of seizures after ACTH therapy, seizures concomitant with spasms and convulsions before the onset of spasms. Poor prognostic factors for physical development were delayed development before the onset of spasms, neurological abnormalities, PEG abnormality, symptomatic etiology, neonatal convulsions, low birthweight, perinatal asphyxia and being female. Poor prognostic factors for mental development were delayed development before the onset of spasms, neurological abnormalities, PEG [pneumoencephalogram] abnormality, prenatal and perinatal etiology, relapse after initial ACTH therapy, laughing attacks and evolution into other types of fits. Only in the cryptogenic cases was there significant correlation between the delay in treatment and the long-term prognosis for mental development. Poor prognostic factors for educability were very similar to those for mental development. In spite of conflicting views as to the long-term effects of ACTH, prompt treatment seems to be mandatory, at least in cryptogenic cases of infantile spasms.