Clinical characteristics of children with infantile epileptic spasms syndrome from a tertiary-care hospital in Dhaka, Bangladesh
Christina Briscoe Abath,
Narayan Chandra Saha,
Seikh Azimul Hoque,
Ariful Islam,
Yamin Shahriar Chowdhury,
Mosammat Shameem Ara Begum,
Tahera Sultana Davalji Kanjiker,
Christopher J. Yuskaitis,
Chellamani Harini,
Md Badrul Alam,
Quazi Deen Mohammed,
Maitreyi Mazumdar
Affiliations
Christina Briscoe Abath
Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, USA
Narayan Chandra Saha
Department of Pediatric Neurology, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
Seikh Azimul Hoque
Department of Pediatric Neurology, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
Ariful Islam
Department of Pediatric Neurology, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
Yamin Shahriar Chowdhury
Department of Pediatric Neurology, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
Mosammat Shameem Ara Begum
Department of Pediatric Neurology, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
Tahera Sultana Davalji Kanjiker
Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, USA
Christopher J. Yuskaitis
Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, USA
Chellamani Harini
Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, USA
Md Badrul Alam
Department of Pediatric Neurology, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
Quazi Deen Mohammed
Department of Pediatric Neurology, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
Maitreyi Mazumdar
Department of Pediatric Neurology, National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh; Corresponding author.
Background: We describe patient characteristics and response to initial treatment in a large case series of children presenting with infantile epileptic spasms syndrome to a tertiary-care hospital with a pediatric neurology service in Bangladesh. The purpose of the study was to add to the growing body of literature on infantile epileptic spasms syndrome in low- and middle-income countries. Methods: We enrolled 212 infants with new-onset infantile epileptic spasms syndrome (IESS) at the time of initial presentation to the National Institute of Neurosciences and Hospital (NINS) in Dhaka, Bangladesh, between January 2019 and August 2021. We collected data about seizure type and frequency, etiology, medication dosage, and available neuroimaging. Results: Median age at initial presentation to NINS was 9 months. Developmental delay and regression prior to presentation were found in 83% and 36%, respectively. Prior to their presentation at NINS, 197 (93%) patients had received anti-seizure medication to treat spasms, of whom only 8 (4%) had received standard therapy with ACTH, prednisolone, or vigabatrin. At NINS, 207 (98%) of patients received standard therapy, most frequently ACTH in 154 (73%). Median time between seizure onset to receipt of first-line therapy was 5 months. Of the 169 patients who were seen in follow-up at average of 5 weeks, 92 (54%) reported absence of clinical epileptic spasms. No serious adverse events requiring hospitalization were reported. Conclusions: This study highlights the long lead times to treatment for IESS in a low- and middle-income country, and the need for early referral of children with suspected epileptic spasms to epilepsy care centers.
