Comparison of treatment efficacy between oral steroid and ketogenic diet for patients with infantile spasm

Abstract

Purpose: Infantile spasm is an age-dependent unique epilepsy syndrome characterized by clinical spasm, hypsarrhythmia at a particular age usually around 5 months. There are only few pharmacological and non-pharmacological treatments. Comparing the efficacy of oral steroid and that of ketogenic diet (KGD) may be beneficial to suggest which treatment should be considered first, in the early stage after pharmacological failure.Methods: We reviewed 132 patients with infantile spasm who tried oral steroid or ketogenic diet treatments. We excluded children: who did not have typical hypsarrhythmia; who tried >3 anti-epileptic drugs (AEDs) before hormone or KGD; and who tried those treatments after 24-month old. Treatment efficacy was measured as seizure outcome in 3-month and long term final outcome: seizure free; >90% reduction; >50%; <50%; and no change.Results: There was no difference in demographics between groups who tried hormone or KGD. Seizure outcome in 3 months was not statistically different between two groups. Median follow-up period was 3.1 years. Overall 17 of 54 (31.5%) patients evolved into Lennox-Gastaut syndrome (LGS). Eventual numbers of patients without seizure did not significantly differ between groups. Patients with seizure free in 3 months had been treated earlier with hormone/KGD after seizure-onset compared to those without (p=0.004). In addition, who responded better showed earlier response compared to who did not (p=0.015).Conclusion: Ketogenic diet should be considered as early treatment option with a first line AED failure.