Treatment of Infantile Spasms with Sodium Valproate followed by Benzodiazepines
Narong Auvichayapat MD*, Sompon Tassniyom MD*, Sutthinee Treerotphon MD*, Paradee Auvichayapat MD**
Affiliation : * Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen ** Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen
Objective : To review the result of the infantile spasms’ treatment with sodium valproate followed by nitrazepam
or clonazepam.
Study
Design : Descriptive retrospective study.
Setting : Srinagarind Hospital, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon
Kaen, Thailand.
Materials and Methods : Twenty-four infantile spasms admitted between January 1994 and December 2003
were analyzed. The inclusion criteria were the patients with infantile spasms clinically diagnosed by the
pediatric neurologist, having hypsarrhythmic pattern EEG, and receiving sodium valproate with or without
nitrazepam or clonazepam. The patients who had an uncertain diagnosis, incomplete medical record, or that
were incompletely followed up were excluded. Data were collected on sex, age at onset of seizure, type of
infantile spasms, associated type of seizure, predisposing etiological factor, neuroimaging study, and the
result of treatment including cessation of spasms, subsequent development of other seizure types, quantitative
reduction of spasms, relapse rates of spasms, psychomotor development, and adverse effects of AEDs.
Results : The mean age at onset was 177 days. The male-to-female ratio was 1:1.2. There were 13 cryptogenic
(54.2%) and 11 symptomatic (45.8%) infantile spasms. The most common predisposing etiological factors in
symptomatic cases were hypoxic ischemic encephalopathy (45.5%) and microcephaly (36.4%), respectively.
Ten patients received sodium valproate (41.7%), another 10 received sodium valproate with clonazepam
(41.7%), and four received sodium valproate with nitrazepam (16.7%). Both, the complete cessation rate and
the 50% reduction of spasms rate were 45.8%. The duration to complete cessation was 70 days. The relapse
rate was 18.2%. The rate of delayed psychomotor development was 83.3%. The mean duration of follow-up
was 49.6 months.
Conclusion : The authors propose to use sodium valproate concomitantly with benzodiazepines, especially
clonazepam, in situations such as unavailability, intolerability, or adverse effects of ACTH or vigabatrin, or in
a patient who does not respond to ACTH or vigabatrin.
Keywords : Infantile spasms, Sodium valproate, Benzodiazepines, Clonazepam, Nitrazepam, ACTH, Vigabatrin
