OBJECTIVE: We conducted a retrospective observational study at the Kazan Municipal children's hospital № 8 among children with
West syndrome. When treatment with
tetracosactide (
synacthen depot) or
antiepileptic drugs was initiated within 1 month after the onset of
seizures we defined it as "early treatment initiation". If this
therapy was started after 1 month of the onset of
seizures, we defined it as "late treatment initiation". We used was the number of seizure-free patients after 2 months, 6 months and 1 year from the start of the treatment as the favorable outcome measure. We calculated risk ratios (RR) for favorable outcomes and their confidence intervals (CI) using RevMan 5.3 Software, comparing outcomes of early and late treatments.
RESULTS: We analyzed medical records of 150 children with
infantile spasms. The diagnosis of
West syndrome was confirmed by video-EEG-monitoring findings and by clinical examinations. Gender distribution of patients with
West syndrome was with some predominance of boys: 93 boys (62%) and 57 girls (38%), which corresponded to the published literature data. The duration of follow-up was at least 3.5 years. The mean age of patients at the time of analysis was 6 years, from 4 years (min) to 14 years 5 months (max). We divided all of the children into four groups:Group IA - early treatment initiation - included children who were started on
tetracosactide within 1 month from the onset of
seizures (30 patients).Group IB - late treatment initiation - included children who were started on
tetracosactide after 1 month of the onset of
seizures (60 patients).Group IIA - early treatment initiation - included children who were started on
antiepileptic drugs as mono- or polytherapy within 1 month from the onset of
seizures (22 patients).Group IIB - late treatment initiation - included children who were started on
antiepileptic drugs after 1 month of the onset of
seizures (38 patients).Children in all groups were similar with respect to age, sex, severity of the disease. Effectiveness of
tetracosactide in the group IA and in the group IB at 2 months, 6 months and 1 year of follow up (from the beginning of treatment) was comparable: RR = 1.00; 95% CI [0.79, 1.27]; P = 1,00; RR = 0.96; 95% CI [0.74, 1.24]; P = 0,74; RR = 1.00; 95% CI [0.75, 1.33]; P = 1,00; respectivelyComparative analysis of the effectiveness of treatment with
antiepileptic drugs (without
tetracosactide) at 2 months, 6 months and 1 year of follow up (from the initiation of treatment) demonstrated that the number of patients achieving clinical remission was higher in the group IIA, in which the
therapy was started within 1 month of the onset of the disease versus the "late treatment initiation" group IIB: RR = 2.76; 95% CI [1.03, 7.41]; P = 0,04; RR = 1.62; 95% CI [1.01, 2.59]; P = 0,04; RR = 1.37; 95% CI [1.02, 1.84]; P = 0,04; respectively.
CONCLUSIONS: