THE TREATMENT OF INFANTILE SPASMS BY CHILD NEUROLOGISTS

Infantile spasms is a refractory seizure disorder for which a number o f different treatment regimens are available. No information is availa ble on which treatment regimens are most widely used and which would b e of practical importance in designing clinical trials to determine ef ficacy of new treatments. We proceeded to gather data on the most comm only employed methods of treating infantile spasms. A survey was maile d in 1991 to all junior, active, and emeritus members of the Child Neu rology Society asking details about the treatment of infantile spasms. Telephone follow-up on a random sample of nonresponders was made. The total response rate was 58.3%. Most respondents who treat infantile s pasms use corticotropin (ACTH) as their drug of first choice (88%). Th e most frequently used dosage was 40 IU per day, and the most frequent duration of treatment was 1 to 2 months. The most frequently reported side effects of ACTH or oral corticosteroid treatment were cushingism , behavior changes or irritability, hypertension, topical infections, and systemic infections. Of those not using ACTH, valproic acid was th e next most commonly employed agent, followed by oral corticosteroids. The results were similar for all respondents regardless of age, sex, type of practice, number of cases of infantile spasms seen, location ( United States or abroad) or whether the survey was completed by mail o r telephone. These data suggest that there is a relative uniformity am ong child neurologists in the management of infantile spasms despite t he publication of many alternative treatment strategies.