Response to second treatment after initial failed treatment in a multicenter prospective infantile spasms cohort

• DOI: 10.1111/epi.13557
• Publication Date: 2016-09-12T06:49:55Z
• Authors: Kelly G. Knupp; Erin Leister; Jason Coryell; Katherine C. Nickels; Nicole Ryan; Elizabeth Juarez‐...; William D. Gaillard; John R. Mytinger; Anne T. Berg; John Millichap; Douglas R. Nordli; Sucheta Joshi; Renée A. Shellhaas; Tobias Loddenkemper; Dennis Dlugos; Elaine Wirrell; Joseph Sullivan; Adam L. Hartman; Eric H. Kossoff; Zachary M. Grinspan; Lorie Hamikawa
• Keywords: Male; Medicine (General); Clinical Sciences; Clinical Trials and Supportive Activities; Clinical sciences; Infantile; Vigabatrin; Spasms; Cohort Studies; Adrenocorticotropic Hormone; Clinical Research; Health Sciences; Humans; Treatment Failure; Pediatric; Neurology & Neurosurgery; Biomedical and Clinical Sciences; Infantile spasms; Secondâ line treatment; Neurosciences; Evaluation of treatments and therapeutic interventions; Infant; Pediatric Epilepsy Research Consortium; 3. Good health; 6.1 Pharmaceuticals; Second-line treatment; Anticonvulsants; Female; Adrenocorticotropic hormone; Spasms, Infantile

SummaryObjectiveInfantile spasms (IS) represent a severe epileptic encephalopathy presenting in the first 2 years of life. Recommended first‐line therapies (hormonal therapy or vigabatrin) often fail. We evaluated response to second treatment for IS in children in whom the initial therapy failed to produce both clinical remission and electrographic resolution of hypsarhythmia and whether time to treatment was related to outcome.MethodsThe National Infantile Spasms Consortium established a multicenter, prospective database enrolling infants with new diagnosis of IS. Children were considered nonresponders to first treatment if there was no clinical remission or persistence of hypsarhythmia. Treatment was evaluated as hormonal therapy (adrenocorticotropic hormone [ACTH] or oral corticosteroids), vigabatrin, or “other.” Standard treatments (hormonal and vigabatrin) were compared to all other nonstandard treatments. We compared response rates using chi‐square tests and multivariable logistic regression models.ResultsOne hundred eighteen infants were included from 19 centers. Overall response rate to a second treatment was 37% (n = 44). Children who received standard medications with differing mechanisms for first and second treatment had higher response rates than other sequences (27/49 [55%] vs. 17/69 [25%], p < 0.001). Children receiving first treatment within 4 weeks of IS onset had a higher response rate to second treatment than those initially treated later (36/82 [44%] vs. 8/34 [24%], p = 0.040).SignificanceGreater than one third of children with IS will respond to a second medication. Choosing a standard medication (ACTH, oral corticosteroids, or vigabatrin) that has a different mechanism of action appears to be more effective. Rapid initial treatment increases the likelihood of response to the second treatment.