Introduction

Infantile spasms are an age-specific type of epilepsy. Epilepsy is a long-term brain condition that causes repeated seizures. Seizures are uncontrolled changes in your child’s movement and behaviour. They are caused by a disruption in the brain's normal electrical activity. 

Infantile spasms usually start when a baby is 3–7 months old. They can be subtle and sometimes hard to notice in the beginning. 

Infantile spasms can be caused by:

• changes in the structure of the brain as it develops
• brain injury – including injury before, during or after birth and from Infections
• genetic conditions - caused by changes in a child’s DNA
• metabolic conditions- problems with how the body turns food into energy.

Infantile spasms can affect your child’s development, so early diagnosis and management are important to help lower the risk of developmental delays.

The main symptom of infantile spasms is clusters of short seizures.

Infantile spasms can be hard to notice. They will usually: 

• happen in clusters, with several spasms in a row lasting for several minutes
• be very short, lasting 1-3 seconds each
• have short pauses between each spasm, where your child will become more aware and may interact.

They may also happen as your child is falling asleep or waking up and can happen several times a day.

Infantile spasms may look slightly different in each child. During a spasm, a child may:

• drop their head
• suddenly bend forward
• stiffen their body, arms or legs
• pull their arms or legs toward their body
• have extensor spasms - fling their arms and legs outward
• roll their eyes
• become irritable or cry.

Infantile spasms can affect your child’s development because of the effect that the spasms have on brain waves. After spasms start, a child may:

• slow down in development, or lose skills they have already learned
• stop focusing on caregivers or responding to sounds or words
• stop smiling or interacting as they did before.

If you think your child is having infantile spasms, seek medical help as soon as possible. This could include:

• seeing your local doctor
• seeing a paediatrician
• going to the emergency department. 

To diagnose infantile spasms, your child’s doctor will usually:

• ask for a description of the spasms and when they happened
• watch a spasm happen in person, or from a video taken by a parent or carer
• ask about your child’s medical history
• do a physical check
• do an electroencephalogram (EEG) - a test that records brain activity using small sensors on the head.

Other tests may be done to find out why the spasms are happening, including: 

• Magnetic resonance imaging (MRI) scan – to get a detailed picture of the brain
• blood and urine tests
• genetic tests- looking for any changes in the genes.

Early treatment is important to help:

• stop spasms
• support development
• reverse any effects on development as much as possible.

The first treatment usually depends on the cause of the spasms and may include:

• an anti-seizure medication called ‘vigabatrin’
• steroid or hormone treatments, like prednisolone or adrenocorticotropic hormone (ACTH)
• a combination of the two.

After the first treatment, the doctor may adjust your child’s care depending on how they are responding.

Treatments may then include:

• more anti-seizure medication
• The ketogenic diet - a high-fat, low-carb diet that may reduce seizures in some children
• Surgery – only in some cases.

Your child’s doctor will often do follow-up EEGs to check how the spasms are responding to treatments.

Your child may also need support for any developmental changes. This is done through regular therapies, including:

• physiotherapy
• occupational therapy
• speech therapy.