[PS5-1A-3] Syndrome based therapy-2: Treatment of infantile spasms and gaps in the epilepsy treatment in the region
Treatment of epileptic spasms has been under frequent discussion debating on the question of “what is the best form of therapy”. The drug of choice, based on limited evidence as well as preferential choice in different regions of the world has changed different time points. Last decade, witnessed a significant change in the approach to treatment of this condition. A gradual transition from Vigabatrin which was considered drug of choice to use of hormonal therapies as the first line followed the publications from the UKISS trial. The guidelines changed to recognize the role of hormonal therapies as the first line other than in the case of spasms occurring in children with Tuberous sclerosis.
Over the past five years there is new evidence supportive of oral prednisolone as another first line treatment option. This is cheap, universally available and easy to dispense; however, needs a high dose to be effective. Although this may account for a higher frequency of adverse effects, it provides opportunity for early administration and thus early resolution of spasms and the hypsarrhtyhmia. Recognition of its therapeutic value should aid to minimize the treatment gap considering the non-availability and the exorbitant cost associated with ACTH therapy.
In this context, time is right to re-evaluate parameters to decide on the better form of therapy not merely on efficacy but on “effectiveness” which takes into account many other aspects such as affordability, convenient dispensability etc. and thus help reduce the vast treatment gap that prevails in the region
Over the past five years there is new evidence supportive of oral prednisolone as another first line treatment option. This is cheap, universally available and easy to dispense; however, needs a high dose to be effective. Although this may account for a higher frequency of adverse effects, it provides opportunity for early administration and thus early resolution of spasms and the hypsarrhtyhmia. Recognition of its therapeutic value should aid to minimize the treatment gap considering the non-availability and the exorbitant cost associated with ACTH therapy.
In this context, time is right to re-evaluate parameters to decide on the better form of therapy not merely on efficacy but on “effectiveness” which takes into account many other aspects such as affordability, convenient dispensability etc. and thus help reduce the vast treatment gap that prevails in the region