[Proposals for the treatment of children with West's syndrome].

OBJECTIVE

The justification of guidelines for the treatment of children with infantile spasms and West's syndrome.

DEVELOPMENT: We review, by means of prospective studies of suitable methodology, the efficacy and side-effects of adrenocorticotropin, sodium valproate, vigabatrin and other drugs used in the treatment of children with West's syndrome.

CONCLUSIONS

In view of the information obtained from these studies, we suggest that in children with idiopathic or cryptogenic West's syndrome, treatment should be started with oral prednisone up to a dose of 8 mg/kg/day which should be changed to vigabatrin in the case of inefficacy or side effects. In children with secondary or symptomatic West's syndrome, treatment should be started with vigabatrin, up to a maximum dose of 200 mg/kg/day and if this is ineffective or there are side-effects it should be replaced by prednisone. If neither of these forms of treatment are successful, topiramate (up to 24 mg/kg/day) or valproate (up to 200 mg/kg/day) should be given.