Infantile spasms are a significant challenge to treating physicians and is a serious epilepsy syndrome affecting young children that need to be identified, diagnosed and managed rapidly in order to preserve cognitive function for impacted children. In the October 2010 issue of Epilepsia, Drs. Pellock and a host of other investigators provide a U.S. Consensus Report based on a workshop that was conducted on the topic to assess the state of evidence for diagnosis, evaluation and treatment of infantile spasms. The article entitled “Infantile Spasms: A U.S. Consensus Report” (Epilepsia 2010; 51(10):2175-2189) summarizes a consensus of opinion on an approach to the diagnostic evaluation and treatment of this condition. There was strong consensus on the following four conclusions:

1. The need for broad clinical evaluation, including detailed clinical neurophysiology was strongly recommended.
2. ACTH and vigabatrin are the only drugs with proven effectiveness to suppress clinical spasms and abolish the hypsarrhythmic EEG ( a specific EEG pattern found only in this syndrome) in a randomized clinical trial setting and thus remain first line treatments.
3. Regardless of the chosen medication, timely assessment of treatment efficacy, i.e., two weeks for ACTH followed by taper (two weeks or less following dose titration for vigabatrin) and, if indicated, prompt treatment modification is strongly recommended as longer treatment trials, i.e. greater than two weeks for ACTH; greater than three months for vigabatrin are not likely to be effective and may come at the expense of serious adverse events.
4. Effective treatment for infantile spasms should produce both cessation of spasms and resolution of hypsarrhythmia on EEG and is an all or none “response.”

This paper should help guide practitioners looking for more information from experts in the United States are as it pertains to infantile spasm management and treatment.