[1]First Hospital of Jilin University, Changchun, China.
Objective: About half of the children with West syndrome can not get seizure free by initial antiepileptic monotherapy. Aim of this study is to explore the effects of initial polytherapy in newly diagnosed West syndrome. Method: 51 children with West syndrome were included in our study. ACTH therapy was used for intravenous drip at dose of 25 IU or titrated to 40 IU according to the spasms control. TPM was given at an initial dose of 1 mg/kg per day, with a rapid titration of 1 mg/kg once per day until 5 mg/kg if the seizure free was got within 5days or the maintenance dose of 10 mg/kg per day was attained if the spasms were not controlled. IVIG was given for five days per month for consecutive six months at the dose 0.4 g/kg/day. Vitamin B6 was intravenously transfused at the dose 10 mg/kg/day for consecutive 10days. Results: 46 patients became spasm-free through polytheray, two children effective and three ineffective. Statistical difference in time to spasm free was found between cryptogenetic patients and symptomatic cases. Of 46 seizure-free patients, hypsarrythmia was disappeared in 45 children except one with lissencephaly, normal 24 h ambulatory EEG was got in 32 cases with seizure free, spike was found in 15 spasm free children, one case with lissencephaly with seizure free still had hypsarrythmia. Three cases relapsed during the follow-up. Conclusion: Initial polytherapy by combining ACTH, topiramate, vitamin B6 and IVIG in West syndrome is a worthwhile choice in clinic.
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