Hassanzadeh Rad Afagh, Aminzadeh Vahid
Pediatrics Growth Disorders Research Center, School of Medicine, 17th Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Iran J Child Neurol. 2017 Spring;11(2):8-12.
Infantile spasms is diagnosed late even by expert pediatricians. Late diagnosis (later than 3 weeks) can have a negative effect on the long-term prognosis. We aimed to investigate infantile spasms treated with intravenous methylprednisolone pulse.
MATERIALS & METHODS: In this case series study, 20 infants with infantile spasms in 17-Shahrivar Hospital, Rasht, Iran were enrolled. Drugs were administered based on Mytinger protocol that included 3 days of methylprednisolone pulse and 56 days of oral prednisolone. The control of spasms and the omission of hypsarrhythmia in infants follow-up were the primary and secondary outcomes, respectively. Remission was indicated if the caregivers mentioned no spasms or >50% decrease regarding drug initiation for at least 5 consecutive days and the electroencephalography during sleep period noted the omission of hypsarrhythmia.
Eleven female (55%) and 9 male (45%) patients with the mean age of 4.95±1.39 months were enrolled. Mean rapid remission was noted as 4.41±1.50 days. Twelve patients (60%) noted early remission. seizure was controlled in 3(15%) patients completely after 24 months. Five (25%) occasional seizures were noted controlled by routine anticonvulsant drugs after 24 months and 12 (60%) no response was mentioned. Most of the patients (65%) had cryptogenic etiology for infantile spasms. Uncontrolled seizure was mentioned after initial remission.
Methyl prednisolone is an appropriate drug based on easy administering, low cost, and its accessibility.
即使是专业儿科医生，对婴儿痉挛症的诊断也较晚。延迟诊断（超过3周）会对长期预后产生负面影响。我们旨在研究静脉注射甲基强的松龙脉冲治疗婴儿痉挛症的效果。
在这项病例系列研究中，纳入了伊朗拉什特市17 - 沙赫里瓦尔医院的20例婴儿痉挛症患儿。药物给药基于迈廷格方案，包括3天的甲基强的松龙脉冲治疗和56天的口服强的松龙治疗。婴儿随访期间痉挛的控制和高峰失律的消除分别作为主要和次要结局。如果照顾者提到至少连续5天无痉挛或与用药开始时相比痉挛减少>50%，且睡眠期脑电图显示高峰失律消失，则表明病情缓解。
纳入了11名女性（55%）和9名男性（45%）患者，平均年龄为4.95±1.39个月。平均快速缓解时间为4.41±1.50天。12名患者（60%）出现早期缓解。24个月后，3名患者（15%）的癫痫完全得到控制。24个月后，5名患者（25%）的偶发癫痫通过常规抗惊厥药物得到控制，12名患者（60%）无反应。大多数患者（65%）的婴儿痉挛症病因不明。初始缓解后出现癫痫未得到控制的情况。
基于易于给药、成本低和可及性，甲基强的松龙是一种合适的药物。
