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Introduction:Infantile spasms (IS) is a devastating type of epileptic encephalopathy. Epidemiological studies haveshown a symptomatic etiology in 68% of children diagnosed with IS. We describe 4 children whodeveloped IS following acquired brain injury (ABI), with an aim to highlight the diagnostic difficultiesand the positive impact on rehabilitation with appropriate treatment.Results:The age range at the time of brain injury varied between 80 days to 1 year. Two children hadischaemic brain injury following pneumococcal meningitis, one child had extensive hypoxic damagefollowing an out of hospital cardiac arrest and one child had extensive subdural haematomafollowing a non-accidental injury. Onset of infantile spasms was between three to six monthsfollowing ABI. Three of them were in-patient at diagnosis and had a time lag of 1 week to 10 daysfrom symptom onset to treatment initiation. One child had been discharged home and the time lagto treatment initiation was approximately 1.5 months. Steroid treatment based on ICISS protocol1 was initiated following EEG confirmation of hypsarrhythmia. Complete clinical cessation of spasmswas noted between 7 to 21 days. Two of them had recurrence which was treated successfully andthe other two children had evolution of other seizure types.Conclusions:It is challenging to diagnose IS in patients with ABI, particularly with associated neurologicalsymptoms like dystonia. We noted a positive impact on their rehabilitation following successfultreatment of IS and recommend a low threshold for initiation of investigations and treatment for ISin this patient subset.