The effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: Evidence from the United Kingdom Infantile Spasms Study
Summary Purpose: Infantile spasms is a severe infantile seizure disorder. Several factors affect developmental outcome, especially the underlying etiology of the spasms. Treatment also affects outcome. Both age at onset of spasms and lead time to treatment (the time from onset of spasms to start of...
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| Veröffentlicht in: | Epilepsia (Copenhagen) 2011-07, Vol.52 (7), p.1359-1364 |
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| container_title | Epilepsia (Copenhagen) |
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| creator | O’Callaghan, Finbar J. K. Lux, Andrew L. Darke, Katrina Edwards, Stuart W. Hancock, Eleanor Johnson, Anthony L. Kennedy, Colin R. Newton, Richard W. Verity, Christopher M. Osborne, John P. |
| description | Summary
Purpose: Infantile spasms is a severe infantile seizure disorder. Several factors affect developmental outcome, especially the underlying etiology of the spasms. Treatment also affects outcome. Both age at onset of spasms and lead time to treatment (the time from onset of spasms to start of treatment) may be important. We investigated these factors.
Methods: Developmental assessment using Vineland Adaptive Behaviour Scales (VABS) at 4 years of age in infants enrolled in the United Kingdom Infantile Spasms Study. Date of or age at onset of spasms was obtained prospectively. Lead time to treatment was then categorized into five categories. The effects of lead time to treatment, age of onset of spasms, etiology, and treatment on developmental outcome were investigated using multiple linear regression.
Key Findings: Age of onset ranged (77 infants) from 2 months in 21 and not known in 6. Each month of reduction in age at onset of spasms was associated with a 3.1 [95% confidence interval (CI) 0.64–5.5, p = 0.03] decrease, and each increase in category of lead time duration associated with a 3.9 (95% CI 7.3–0.4, p = 0.014) decrease in VABS, respectively. There was a significant interaction between treatment allocation and etiology with the benefit in VABS in those allocated steroid therapy being in children with no identified etiology (coefficient 29.9, p = 0.004).
Significance: Both prompt diagnosis and prompt treatment of infantile spasms may help prevent subsequent developmental delay. Younger infants may be more at risk from the epileptic encephalopathy than older infants. |
| doi_str_mv | 10.1111/j.1528-1167.2011.03127.x |
| format | Article |
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Purpose: Infantile spasms is a severe infantile seizure disorder. Several factors affect developmental outcome, especially the underlying etiology of the spasms. Treatment also affects outcome. Both age at onset of spasms and lead time to treatment (the time from onset of spasms to start of treatment) may be important. We investigated these factors.
Methods: Developmental assessment using Vineland Adaptive Behaviour Scales (VABS) at 4 years of age in infants enrolled in the United Kingdom Infantile Spasms Study. Date of or age at onset of spasms was obtained prospectively. Lead time to treatment was then categorized into five categories. The effects of lead time to treatment, age of onset of spasms, etiology, and treatment on developmental outcome were investigated using multiple linear regression.
Key Findings: Age of onset ranged (77 infants) from <1 to 10 months (mean 5.2, standard deviation 2.1). Lead time to treatment was 7 days or less in 11, 8–14 days in 16, 15 days to 1 month in 8, 1–2 months in 15, >2 months in 21 and not known in 6. Each month of reduction in age at onset of spasms was associated with a 3.1 [95% confidence interval (CI) 0.64–5.5, p = 0.03] decrease, and each increase in category of lead time duration associated with a 3.9 (95% CI 7.3–0.4, p = 0.014) decrease in VABS, respectively. There was a significant interaction between treatment allocation and etiology with the benefit in VABS in those allocated steroid therapy being in children with no identified etiology (coefficient 29.9, p = 0.004).
Significance: Both prompt diagnosis and prompt treatment of infantile spasms may help prevent subsequent developmental delay. Younger infants may be more at risk from the epileptic encephalopathy than older infants.</description><identifier>ISSN: 0013-9580</identifier><identifier>EISSN: 1528-1167</identifier><identifier>DOI: 10.1111/j.1528-1167.2011.03127.x</identifier><identifier>PMID: 21668442</identifier><identifier>CODEN: EPILAK</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Age ; Age at onset ; Age of Onset ; Anticonvulsants - therapeutic use ; Anticonvulsants. Antiepileptics. Antiparkinson agents ; Biological and medical sciences ; Child Development - drug effects ; Child Development - physiology ; Confidence intervals ; Convulsions & seizures ; Cosyntropin - therapeutic use ; Developmental outcome ; Early Diagnosis ; Epileptic spasms ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Infant ; Infant, Newborn ; Infantile spasms ; Lead time to treatment ; Linear Models ; Medical research ; Medical sciences ; Nervous system (semeiology, syndromes) ; Neurology ; Neuropharmacology ; Pharmacology. Drug treatments ; Prednisolone - therapeutic use ; Prognosis ; Spasms, Infantile - diagnosis ; Spasms, Infantile - drug therapy ; Spasms, Infantile - etiology ; Spasms, Infantile - physiopathology ; United Kingdom ; Vigabatrin - therapeutic use</subject><ispartof>Epilepsia (Copenhagen), 2011-07, Vol.52 (7), p.1359-1364</ispartof><rights>Wiley Periodicals, Inc. © 2011 International League Against Epilepsy</rights><rights>2015 INIST-CNRS</rights><rights>Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4937-210d16b527054ea1cef3881e48ae11c027fcb2fbdcc07089dae5f6169ef644793</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1528-1167.2011.03127.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1528-1167.2011.03127.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24383633$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21668442$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O’Callaghan, Finbar J. K.</creatorcontrib><creatorcontrib>Lux, Andrew L.</creatorcontrib><creatorcontrib>Darke, Katrina</creatorcontrib><creatorcontrib>Edwards, Stuart W.</creatorcontrib><creatorcontrib>Hancock, Eleanor</creatorcontrib><creatorcontrib>Johnson, Anthony L.</creatorcontrib><creatorcontrib>Kennedy, Colin R.</creatorcontrib><creatorcontrib>Newton, Richard W.</creatorcontrib><creatorcontrib>Verity, Christopher M.</creatorcontrib><creatorcontrib>Osborne, John P.</creatorcontrib><title>The effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: Evidence from the United Kingdom Infantile Spasms Study</title><title>Epilepsia (Copenhagen)</title><addtitle>Epilepsia</addtitle><description>Summary
Purpose: Infantile spasms is a severe infantile seizure disorder. Several factors affect developmental outcome, especially the underlying etiology of the spasms. Treatment also affects outcome. Both age at onset of spasms and lead time to treatment (the time from onset of spasms to start of treatment) may be important. We investigated these factors.
Methods: Developmental assessment using Vineland Adaptive Behaviour Scales (VABS) at 4 years of age in infants enrolled in the United Kingdom Infantile Spasms Study. Date of or age at onset of spasms was obtained prospectively. Lead time to treatment was then categorized into five categories. The effects of lead time to treatment, age of onset of spasms, etiology, and treatment on developmental outcome were investigated using multiple linear regression.
Key Findings: Age of onset ranged (77 infants) from <1 to 10 months (mean 5.2, standard deviation 2.1). Lead time to treatment was 7 days or less in 11, 8–14 days in 16, 15 days to 1 month in 8, 1–2 months in 15, >2 months in 21 and not known in 6. Each month of reduction in age at onset of spasms was associated with a 3.1 [95% confidence interval (CI) 0.64–5.5, p = 0.03] decrease, and each increase in category of lead time duration associated with a 3.9 (95% CI 7.3–0.4, p = 0.014) decrease in VABS, respectively. There was a significant interaction between treatment allocation and etiology with the benefit in VABS in those allocated steroid therapy being in children with no identified etiology (coefficient 29.9, p = 0.004).
Significance: Both prompt diagnosis and prompt treatment of infantile spasms may help prevent subsequent developmental delay. Younger infants may be more at risk from the epileptic encephalopathy than older infants.</description><subject>Age</subject><subject>Age at onset</subject><subject>Age of Onset</subject><subject>Anticonvulsants - therapeutic use</subject><subject>Anticonvulsants. Antiepileptics. Antiparkinson agents</subject><subject>Biological and medical sciences</subject><subject>Child Development - drug effects</subject><subject>Child Development - physiology</subject><subject>Confidence intervals</subject><subject>Convulsions & seizures</subject><subject>Cosyntropin - therapeutic use</subject><subject>Developmental outcome</subject><subject>Early Diagnosis</subject><subject>Epileptic spasms</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infantile spasms</subject><subject>Lead time to treatment</subject><subject>Linear Models</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Neuropharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>Prednisolone - therapeutic use</subject><subject>Prognosis</subject><subject>Spasms, Infantile - diagnosis</subject><subject>Spasms, Infantile - drug therapy</subject><subject>Spasms, Infantile - etiology</subject><subject>Spasms, Infantile - physiopathology</subject><subject>United Kingdom</subject><subject>Vigabatrin - therapeutic use</subject><issn>0013-9580</issn><issn>1528-1167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdktFqFDEUhgdR7Fp9BQmIeDVjTpKZZAUvpKy6WFBoex2yyUmdZSazTjK1eyf4OL6VT2KmXVcwCZyQ_zuHQ_5TFARoBXm93lZQM1UCNLJiFKCiHJisbh8Ui6PwsFhQCrxc1oqeFE9i3FJKZSP54-KEQdMoIdii-HX5FQl6jzaRwZMOjSOp7ZGkgaQRTeoxJGKCm1VzjXMYQsRMB-LwBrthNyOmI8OU7JAzTSLi94-fezRjJG3Ix5uQ2g5J3JnYxzdkddM6DBaJH4eepNzBVWgTOvKpDdcuP62PKRd3KeQiTW7_tHjkTRfx2SGeFlfvV5dnH8vzzx_WZ-_OSyuWXJYMqINmUzNJa4EGLHquFKBQBgEsZdLbDfMbZy2VVC2dwdo30CzRN0LIJT8tXt3X3Y3Dtwlj0n0bLXadCThMUSsl8lagMvniP3I7TGPIzWmoQTKuRFNn6vmBmjY9Or0b296Me_3XhQy8PAAmWtP50QTbxn-c4Io3nGfu7T33PX_N_qgD1fNU6K2ezdez-XqeCn03FfpWr76s5xv_A51nrEM</recordid><startdate>201107</startdate><enddate>201107</enddate><creator>O’Callaghan, Finbar J. K.</creator><creator>Lux, Andrew L.</creator><creator>Darke, Katrina</creator><creator>Edwards, Stuart W.</creator><creator>Hancock, Eleanor</creator><creator>Johnson, Anthony L.</creator><creator>Kennedy, Colin R.</creator><creator>Newton, Richard W.</creator><creator>Verity, Christopher M.</creator><creator>Osborne, John P.</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7TK</scope><scope>7X8</scope></search><sort><creationdate>201107</creationdate><title>The effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: Evidence from the United Kingdom Infantile Spasms Study</title><author>O’Callaghan, Finbar J. K. ; Lux, Andrew L. ; Darke, Katrina ; Edwards, Stuart W. ; Hancock, Eleanor ; Johnson, Anthony L. ; Kennedy, Colin R. ; Newton, Richard W. ; Verity, Christopher M. ; Osborne, John P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4937-210d16b527054ea1cef3881e48ae11c027fcb2fbdcc07089dae5f6169ef644793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Age</topic><topic>Age at onset</topic><topic>Age of Onset</topic><topic>Anticonvulsants - therapeutic use</topic><topic>Anticonvulsants. Antiepileptics. Antiparkinson agents</topic><topic>Biological and medical sciences</topic><topic>Child Development - drug effects</topic><topic>Child Development - physiology</topic><topic>Confidence intervals</topic><topic>Convulsions & seizures</topic><topic>Cosyntropin - therapeutic use</topic><topic>Developmental outcome</topic><topic>Early Diagnosis</topic><topic>Epileptic spasms</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infantile spasms</topic><topic>Lead time to treatment</topic><topic>Linear Models</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Neuropharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>Prednisolone - therapeutic use</topic><topic>Prognosis</topic><topic>Spasms, Infantile - diagnosis</topic><topic>Spasms, Infantile - drug therapy</topic><topic>Spasms, Infantile - etiology</topic><topic>Spasms, Infantile - physiopathology</topic><topic>United Kingdom</topic><topic>Vigabatrin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>O’Callaghan, Finbar J. K.</creatorcontrib><creatorcontrib>Lux, Andrew L.</creatorcontrib><creatorcontrib>Darke, Katrina</creatorcontrib><creatorcontrib>Edwards, Stuart W.</creatorcontrib><creatorcontrib>Hancock, Eleanor</creatorcontrib><creatorcontrib>Johnson, Anthony L.</creatorcontrib><creatorcontrib>Kennedy, Colin R.</creatorcontrib><creatorcontrib>Newton, Richard W.</creatorcontrib><creatorcontrib>Verity, Christopher M.</creatorcontrib><creatorcontrib>Osborne, John P.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Epilepsia (Copenhagen)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>O’Callaghan, Finbar J. K.</au><au>Lux, Andrew L.</au><au>Darke, Katrina</au><au>Edwards, Stuart W.</au><au>Hancock, Eleanor</au><au>Johnson, Anthony L.</au><au>Kennedy, Colin R.</au><au>Newton, Richard W.</au><au>Verity, Christopher M.</au><au>Osborne, John P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: Evidence from the United Kingdom Infantile Spasms Study</atitle><jtitle>Epilepsia (Copenhagen)</jtitle><addtitle>Epilepsia</addtitle><date>2011-07</date><risdate>2011</risdate><volume>52</volume><issue>7</issue><spage>1359</spage><epage>1364</epage><pages>1359-1364</pages><issn>0013-9580</issn><eissn>1528-1167</eissn><coden>EPILAK</coden><abstract>Summary
Purpose: Infantile spasms is a severe infantile seizure disorder. Several factors affect developmental outcome, especially the underlying etiology of the spasms. Treatment also affects outcome. Both age at onset of spasms and lead time to treatment (the time from onset of spasms to start of treatment) may be important. We investigated these factors.
Methods: Developmental assessment using Vineland Adaptive Behaviour Scales (VABS) at 4 years of age in infants enrolled in the United Kingdom Infantile Spasms Study. Date of or age at onset of spasms was obtained prospectively. Lead time to treatment was then categorized into five categories. The effects of lead time to treatment, age of onset of spasms, etiology, and treatment on developmental outcome were investigated using multiple linear regression.
Key Findings: Age of onset ranged (77 infants) from <1 to 10 months (mean 5.2, standard deviation 2.1). Lead time to treatment was 7 days or less in 11, 8–14 days in 16, 15 days to 1 month in 8, 1–2 months in 15, >2 months in 21 and not known in 6. Each month of reduction in age at onset of spasms was associated with a 3.1 [95% confidence interval (CI) 0.64–5.5, p = 0.03] decrease, and each increase in category of lead time duration associated with a 3.9 (95% CI 7.3–0.4, p = 0.014) decrease in VABS, respectively. There was a significant interaction between treatment allocation and etiology with the benefit in VABS in those allocated steroid therapy being in children with no identified etiology (coefficient 29.9, p = 0.004).
Significance: Both prompt diagnosis and prompt treatment of infantile spasms may help prevent subsequent developmental delay. Younger infants may be more at risk from the epileptic encephalopathy than older infants.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21668442</pmid><doi>10.1111/j.1528-1167.2011.03127.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | Electronic Journals Library; MEDLINE; Wiley Online Library; IngentaConnect Free/Open Access Journals(OpenAccess); Wiley Online Library Free Content; Alma/SFX Local Collection |
| subjects | Age Age at onset Age of Onset Anticonvulsants - therapeutic use Anticonvulsants. Antiepileptics. Antiparkinson agents Biological and medical sciences Child Development - drug effects Child Development - physiology Confidence intervals Convulsions & seizures Cosyntropin - therapeutic use Developmental outcome Early Diagnosis Epileptic spasms Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Infant Infant, Newborn Infantile spasms Lead time to treatment Linear Models Medical research Medical sciences Nervous system (semeiology, syndromes) Neurology Neuropharmacology Pharmacology. Drug treatments Prednisolone - therapeutic use Prognosis Spasms, Infantile - diagnosis Spasms, Infantile - drug therapy Spasms, Infantile - etiology Spasms, Infantile - physiopathology United Kingdom Vigabatrin - therapeutic use |
| title | The effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: Evidence from the United Kingdom Infantile Spasms Study |
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