A 6-month-old child presents with infantile spasms (brief flexion-extension jerks occurring in clusters on awakening). EEG shows hypsarrhythmia. MRI brain is normal. Which treatment has the BEST evidence for improving BOTH seizure control AND neurodevelopmental outcome in cryptogenic infantile spasms?
- A ACTH (adrenocorticotropic hormone) injection ✓
- B Sodium valproate
- C Vigabatrin
- D Topiramate
Explanation
ACTH is the gold-standard treatment for infantile spasms (West syndrome) with the best evidence for both cessation of spasms AND resolution of hypsarrhythmia on EEG, with better neurodevelopmental outcomes compared to oral steroids alone in most studies. Vigabatrin is specifically preferred for tuberous sclerosis-associated infantile spasms (structural cause) due to its superior efficacy in that subgroup but carries the risk of visual field defects. For cryptogenic (now called 'epileptic spasms of unknown cause') cases, ACTH is superior. Sodium valproate and topiramate have limited efficacy for infantile spasms.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.