An Analysis Of The Duration And Clinical Efficacy Of Pre-transition With 63 Infantile Spasms

1、Objective:The clinical and electroencephalogram data,follow-up results and prognosis of 63 infants with pre-transition spasm were retrospectively analyzed2、Data and Methods:2.1 Research object:The clinical data of 63 infantile spasmodic children admitted to the pediatric ward of Qilu hospital of shandong university from January 2016 to January 2019 were retrospectively analyzed,including 40 baby boys and 23 baby girls.2.2 Data:2.2.1 Video brain machine:Adopt Japanese photoelectric machine,place electrode according to international 10-20 standard,double ear electrode as reference.2.2.2 Auxiliary examination:Cranial imaging(CT 10 cases,MRI 51 cases)、Genetic metabolic screening、Genetic testing2.2.3 Treatment medication:①A gleam of medication:ACTH.②Second or third-line antiepileptic drugs:VPA、TPM、LEV、LTG、CZP etc.③Other treatment:KD2.2.4 Follow-up:Outpatient follow-up and telephone follow-up were conducted for 3 months to 2 years,Follow-up included drug use,frequency of attack and prognosis.2.2.5 Clinical efficacy ①evaluation:Turn for the better:No or occasional seizures,Attack once a few weeks or 1-2 months.②poor prognosis:Isolated Convulsive seizure occur more than 3 times a day or in clusters,one or several clusters.2.3Statistical treatment:SPSS22.0 software was adopted3、Result:3.1There were 40 male(63.49%)and 23 female(36.51%)infants.The onset was 1≤year in 50 patients(79.36%),and>1 year in 13 patients(20.64%).Duration of the transition was 44 days to 23 months,average 8.06 months,median 6 months.The interval of seizure transition was ≤3 months in 10 patients(15.87%),and>3 months in 53 patients(84.13%).Latent causes were found in 28 cases(44.44%)and no obvious causes were found in 35 cases(55.56%).MRI abnormalities were found in 17 cases(26.98%),and none in the remaining 46 cases(73.02%).Thirty-one children had genetic tests,and the remaining 32 children refused.VEEG confirmed that 32 cases(50.79%)had the first tonic episode as the transition point,and 31cases(49.2%)had transition point mixed with other seizure types.The VEEG of 16 children(25.39%)was generalized moderate to extremely high amplitude multiple-spike slow waves and spike slow waves,and the EMG burst at the same time was about 120ms,that is,myoclonic seizure.In 14 cases(22.22%),VEEG was a generalized moderate to extremely high amplitude spike and slow wave pattern.Meanwhile,the EMG Silent Period was about 150ms,which was the onset of atonic seizure.VEEG was localized in 1 patient(1.58%),indicating focal tachycardia.In 20 cases(31.74%),VEEG was continuous release of moderate to extremely high amplitude 1.5～2.6hz slow spike and ware complex;indicating atypical absence.3.2 Clinical spasm remission was related to gender and transition interval,and the differences were statistically significant(P<0.05),but not related to the age of onset and the presence of latent etiology(P>0.05).There was no significant difference between the first-line drug ACTH group and the non-acth group(P>0.05).Among the second-line and third-line drugs,1 patient whose family members refused to take the medicine was excluded,and the rest of the patients who chose two-line,three-line or above drugs were statistically significant(P<0.05).The difference between the ketogenic diet group and the ketogenic diet group was statistically significant(P<0.05).4、Conclusion:The remission rate of spasm is worse in males than in females and those with duration of spasm before transition have better prognosis.