EPILEPTIC SPASMS IN OLDER CHILDREN - PERSISTENCE BEYOND INFANCY

Although infantile spasms (IS) constitute a well-recognized epileptic syndrome, only recently did investigators propose that spasms be class ified as a distinct seizure type, characterized by axial flexion/exten sion jerks in clusters. Five older children (aged 4.5-14.2 years) who underwent video-EEG monitoring in 1992 in our epilepsy program for int ractable mixed seizure disorder (cryptogenic 1, symptomatic 4) demonst rated flexor and extensor spasms in clusters. Seizure onset was from b irth to 1.33 years. All 5 had spasms during infancy that continued as the children aged. Ictal EEG during spasms showed a brief high-amplitu de delta burst followed by diffuse background attenuation or diffuse b ackground decrease with superimposed rhythmic beta or alpha activity. Multiple other seizure types were present. Interictal EEGs were marked ly abnormal and demonstrated slowing, multifocal spikes, generalized s low spike-wave, and polyspike-wave. Two children with spasms were unsu ccessfully treated with ACTH, and 3 underwent corpus callosotomy. We c onclude that spasms occur in older children with intractable mixed sei zure disorders and may persist beyond infancy.