SUMMARY A follow‐up study was made on 200 children (115 boys, 85 girls) who had had infantile spasms, in order to compare their present condition over the age of six years with various prognostic factors. 48 of the children (30 males and 18 females) had died, and all the rest were aged six years or older at the time of final follow‐up. 139 of the children had received ACTH therapy: at final follow‐up, spasms had ceased in 43.5 per cent, and about the same proportion showed normal physical development; 23 per cent had normal mental development and 15.4 per cent were attending ordinary schools. Complete recovery (normal mental and physical development and attending ordinary schools) was achieved in only 19 cases (9.5 per cent). Of the cryptogenic cases, 44.4 per cent had made a full recovery. The poor prognostic factors for continuing seizures were evolution into other types of fits, relapse of seizures after ACTH therapy, seizures concomitant with spasms, and convulsions before the onset of spasms. Poor prognostic factors for physical development were delayed development before the onset of spasms, neurological abnormalities, PEG abnormality, symptomatic aetiology, neonatal convulsions, low birthweight, perinatal asphyxia and being female. Poor prognostic factors for mental development were delayed development before the onset of spasms, neurological abnormalities, PEG abnormality, prenatal and perinatal aetiology, relapse after initial ACTH therapy, laughing attacks, and evolution into other types of fits. Only in the cryptogenic cases was there significant correlation between the delay in treatment and the long‐term prognosis for mental development. Poor prognostic factors for educability were very similar to those for mental development. In spite of conflicting views as to the long‐term effects of ACTH, prompt treatment seems to be mandatory, at least in cryptogenic cases of infantile spasms. RÉSUMÉ Pronostic á long terme des spasmes infantiles: étude stalistique des facteurs pronostiques dans 200 cas Une étude longitudinale a été entreprise chez 115 garçons et 85 filles ayant eu des spasmes infantiles dans le but de comparer leur condition présente à l̂âge de six ans ou plus avec des facteurs pronostiques variés. 48 des enfants (30 garçons et 18 filles) sont morts, tous les autres étaient âgés de six ans au moins à la fin de l̂étude longitudinale. 139 des enfants avaient reçu un traitement d̂ACTH. A la fin de l̂étude, les spasmes avaient cessé dans 43,5 pour cent des cas et une proportion identique présentait un développement physique normal; 23 pour cent avaient un développement mental normal et 15,4 pour cent fréquentaient une école ordinaire. La ‘guérison complète’ (développement mental et physique normaux, fréquentation d̂une école ordinaire) n'était observée que dans 19 cas (9,5 pour cent). Parmi les cas d̂origine inconnue, 44,4 pour cent presentaient une guerison complète. Les facteurs de mauvais pronostic pour la continuation des crises étaient l̂évolution vers d̂autres types...
Abstract. The etiological factors, clinical aspects and long term prognosis were studied in 200 patients with infantile spasms. Forty-eight (24.0%) died and the rest were aged 6 years or more at the time of final follow-up. In 73 (36.5%) the etiology was prenatal, in 44 (22.0%) perinatal, and in 17 (8.5%) postnatal: 18 cases (9.0%) were cryptogenic. The remaining 4.8 (24.0%) patients were doubtful cases. The mortalily of the pre-and perinatal cases at 35.6% and 34.1% respectively was significantly higher than that in the other etiologic groups (P< 0.001).With regard to the onset of spasms, these were very early in the pre-and perinatal groups, whereas in the postnatal group the onset was late. The onset in the doubtful and cryptogenic groups was in between. Some 44.4% of the cryptogenic cases showed normal mental and physical development after the age of 6 years, whereas less than 10% of the prenatal and perinatal group did so, Almost all of the doubtful cases became mentally subnormal.The incidence of a family history of epilepsy or other convulsive disorders in the first, second and third degree relatives was highest in the cryptogenic cases (40.0%), and lowest in the perinatal cases (9.3%) (P<0.01). The incidence of laughing attacks was highest in the postnatal cases (42.9%), against no such attacks in cryptogenic cases (P<0.01). The attacks seemed to be linked with organic brain lesions. Among various factors related to the etiology of infantile spasms, genetic propensity seemed especially important in cryptogenic cases.
A follow-up study was made on 304 children (164 boys, 140 girls) with convulsive disorders, excluding occasional convulsions, in the first year of life. All patients except 45 who died were followed until 6 years of age or older. At the final follow-up, the subjects were divided into six groups according to the degree of mental and physical development (groups I-VI). Seizures were regarded as absent if the patient had been seizure free for more than 3 years. At the final follow-up, seizures had ceased in 57.7%, and 43.4% had normal mental and physical development (group I). As to the initial diagnosis, the percentage of group I at the final follow-up was 81.8% with febrile convulsions and 37.6% with epilepsy. In patients without seizures it was 69.7% with febrile convulsions and 55.8% with epilepsy. Some 80.6% of patients with unclassified generalized motor seizures, 11.5% of those with infantile spasms, 2.9% of those with secondary generalized epilepsy other than infantile spasms, 46.4% of those with partial seizures, and 25.0% of those with hemiconvulsive seizures were finally placed in group I. The percentage of patients without seizures was 81.4, 33.0, 34.4, 57.7, and 100%, respectively. As has been suggested, among the first-year epilepsies, a subgroup with a more favorable prognosis may exist. Further studies regarding the etiology, ictal EEGs, and effectiveness of treatment and long-term prognosis of these cryptogenic benign infantile convulsions are needed to provide a firm basis for understanding convulsive disorders in the first year of life.
SUMMARY Quantitative analysis made on spindle‐like fast rhythms in the eegs of 39 low‐birthweight infants (28 pre‐term and 11 small‐for‐dates) resulted in four main findings. Spindle‐like fast rhythms occurred least frequently in the frontal area and most frequently in the occipital and/or central areas. They occurred more frequently at 31–32 weeks' post‐conceptional age than at 26–30 weeks, in all behavioural states. After 31 to 32 weeks they decreased with increasing age, to disappear completely around term. They disappeared earlier in rem sleep than in non‐REM sleep. A greater number of fast rhythms occurred in rem sleep than in deep sleep at 26 to 32 weeks, while at 33 to 34 weeks the situation was reversed, with more fast rhythms in deep sleep than in rem sleep. The same trend was found for both the pre‐term and the small‐for‐dates infants. The study provides further quantitative evidence in favour of previous findings that cns development is more closely related to post‐conceptional age than to post‐natal age or birthweight. RÉSUMÉ Rythmes rapides en fuseaux dans les eeg d'enfants defaible poids de naissance L'analyse quantitative des rythmes rapides en fuseau dans les eeg de 39 enfants de faible poids de naissance (28 prématurts et 11 enfants de poids faible pour le terme) a mis en évidence quatre faits principaux. Les rythmes rapides en fuseau surviennent le moins fréquemment dans les rtgions occipitales et/ou centrales. Ils sont plus fréquents à 31–32 semaines d'âge conceptuel qu'à 26–30 semaines et ceci dans tous les états de comporte‐ments. Après 31–32 semaines, ils décroissant avec lâge, jusqu'à disparaitre complètement vers le terme. Ils disparaissent plus tôt dans le sommeil rapide que dans le sommeil lent. Un plus grand nombre de rythmes rapides surviennent dans le sommeil rapide que dans le sommeil lent de 26 à 32 semaines, tandis qu'on note l'inverse de 33 à 34 semaines. Les mêmes caractéristiques se trouvent chez les prématurés que chez les enfants de faible poids pour le terme. L'étude fournit des éléments quantitativs en faveur des faits précédents qui indiquaient déjà que le développement du snc est plus étroitement reliéà I'âge conceptuel qu'à l'âge de naissance ou au poids de naissance. ZUSAMMENFASSUNG Spindel ähnliche schnelle Rhythmen in EEGs von Kindern mit niedrigem Geburtsgewicht Die quantitative Analyse der Spindel ähnlichen schnellen Rhythmen in eegs von 39 Kindern mit niedrigem Geburtsgewicht (28 Frühgeborene und 11 ‘small for dates’) ergab vier wichtige Befunde. Spindel ähnliche schnelle Rhythmen treten selten in der Frontal‐region und am häufigsten in den Occipital‐ und/oder Zentral‐regionen auf. Sie traten häufiger in der 31–32 igsten Gestationswoche als in der 26–30 igsten auf in allen Verhaltens‐stadien. Nach der 31–32 igsten Woche ließen sie mit zunehmendem Alter nach und verschwanden vollständig etwa zum normalen Geburtstermin. Sie verschwanden eher im aktiven als im ruhigen Schlaf. In der 26–32 igsten Woche fand sich ein größerer Anteil schneller Rhythmen im REM‐...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.