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- Title
Treatment of children with infantile spasms: A network meta-analysis.
- Authors
Jain, Puneet; Sahu, Jitendra K.; Horn, Paul S.; Chau, Vann; Go, Cristina; Mahood, Quenby; Arya, Ravindra
- Abstract
<bold>Aim: </bold>We performed a systematic review and network meta-analysis (NMA) to obtain comparative effectiveness estimates and rankings of non-surgical interventions used to treat infantile spasms.<bold>Method: </bold>All randomized controlled trials (RCTs) including children 2 months to 3 years of age with infantile spasms (with hypsarrhythmia or hypsarrhythmia variants on electroencephalography) receiving appropriate first-line medical treatment were included. Electroclinical and clinical remissions within 1 month of starting treatment were analyzed.<bold>Results: </bold>Twenty-two RCTs comparing first-line treatments for infantile spasms were reviewed; of these, 17 were included in the NMA. Both frequentist and Bayesian network rankings for electroclinical remission showed that high dose adrenocorticotropic hormone (ACTH), methylprednisolone, low dose ACTH and magnesium sulfate (MgSO4 ) combination, low dose ACTH, and high dose prednisolone were most likely to be the 'best' interventions, although these were not significantly different from each other. For clinical remission, low dose ACTH/MgSO4 combination, high dose ACTH (with/without vitamin B6 ), high dose prednisolone, and low dose ACTH were 'best'.<bold>Interpretation: </bold>Treatments including ACTH and high dose prednisolone are more effective in achieving electroclinical and clinical remissions for infantile spasms.<bold>What This Paper Adds: </bold>Adrenocorticotropic hormone and high dose prednisolone are more effective than other medications for infantile spasms. Symptomatic etiology decreases the likelihood of remission even after adjusting for treatment lag.
- Subjects
VITAMIN therapy; ANTICONVULSANTS; METHYLPREDNISOLONE; MAGNESIUM sulfate; INFANTILE spasms; META-analysis; SYSTEMATIC reviews; TREATMENT effectiveness; ADRENOCORTICOTROPIC hormone
- Publication
Developmental Medicine & Child Neurology, 2022, Vol 64, Issue 11, p1330
- ISSN
0012-1622
- Publication type
Article
- DOI
10.1111/dmcn.15330