The treatment of infantile spasms is unlike that of other epilepsies. Treatment usually consists of giving a steroid, either by intramuscular injection, or by mouth. The drug which is given by injection is called ACTH (adrenocorticotrophic hormone), and by mouth, prednisolone. The injections are usually given once (rarely twice) a day for two weeks until the spasms have stopped, and then every other day, and eventually just once a week. Only about one half to
two-thirds of children will respond to ACTH or prednisolone, and a number of these children will relapse (have further spasms) once the medication is discontinued. Unfortunately, these medications may be associated with serious side-effects, and therefore the children must be monitored very closely. Other drugs which may be useful in treating spasms include: sodium valproate (Epilim) and nitrazepam (Mogadon). More recently, one of the newer anti-epileptic drugs, vigabatrin (Sabril) is appearing to be successful in treating spasms, particularly if the cause is tuberous sclerosis or as a result of earlier meningitis/encephalitis. This drug seems to be safer, with less serious side-effects, than the steroid drugs. It may soon become the ‘first choice’ drug in the treatment of infantile spasms. One of us already uses vigabatrin to treat every child who has infantile spasms, irrespective of the cause because it appears to have so few side-effects.