Impact of etiology and lead time to treatment with first-line agents on outcome of infantile epileptic spasms syndrome-A retrospective cohort from LMIC.

OBJECTIVE

To analyse the etiological spectrum, safety and effectiveness of first-line agents and developmental outcomes of children with Infantile Epileptic Spasms Syndrome (IESS) managed at a tertiary-care hospital in South India, focusing on the influence of lead time to treatment.

METHODS

This retrospective cohort study included 65 children diagnosed with IESS between 2020 and 2025. Lead time to treatment was categorized as ≤1 week, 1-2, 3-8, and >8 weeks. First-line therapies included high-dose oral corticosteroids, vigabatrin, or sequential therapy. Treatment response was assessed at one and three months and developmental outcomes at follow-up.

RESULTS

The median age at onset of spasms was 6 months (IQR 5,8) and the median treatment lag 4 weeks (IQR 1,12) with only 26% treated within the first week. Structural-acquired etiologies predominated (36/65; 55.3%), commonly periventricular leukomalacia (24.6%) and neonatal hypoglycaemic brain injury (13.8%). Spasm cessation occurred in 62% at one month and was sustained in 55.4% at three months, with a relapse rate of 15.4%. High-dose oral corticosteroids achieved a significantly higher one-month response than vigabatrin or sequential therapy (p = 0.006). Earlier treatment showed numerically better responses without statistical significance. Adverse effects occurred in 48%, most commonly irritability (64.5%) and weight gain (22.5%). At a mean follow-up of 19.4 months, approximately one-third of children achieved normal or borderline developmental outcomes.

CONCLUSION

Structural-acquired etiologies predominated, and lead time did not significantly influence treatment response. Our findings support that high-dose oral corticosteroids appear to be an effective, practical, and reasonably safe first-line therapy for IESS in resource-limited settings.