Infantile spasms are the most common catastrophic epilepsy in childhood. Children who have infantile spasms that are drug resistant should be referred to a qualified pediatric epilepsy surgeon at a level 4 Epilepsy Surgery facility as soon as possible. There, the team will determine whether resection surgery (removing part, and in some cases disconnecting/removing up to half, of the brain) is recommended.
The criteria for resective surgery for infantile spasms are:
- the infantile spasms are drug-resistant;
- the child has stopped developing (developmental arrest) or has regressed;
- there is no evidence of diffuse brain damage on imaging studies;
- there is a “zone of cortical malformation” on MRI or PET scan;
- there is no evidence of metabolic or degenerative disease;
- there is no undue risk of “unacceptable deficits” after resective surgery.
Dr. Don Shields, a renowned expert in infantile spasms, discusses infantile spasms, cognitive prognosis, and hemispherectomy surgery to stop infantile spasms here:
Pellock, J. et al. Infantile spasms: A U.S. consensus report. Epilepsia, 51(1): 2184 (2010).
Shields, W. Catastrophic epilepsy in childhood. Epilepsia, 41 (Suppl 2): S2-S6, 2000.