P 3 MO YI CONCERN INFANTILE SPASM

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Here is a structured paediatric plan of management for a 3-month-old infant with concern for infantile spasms (also known as West Syndrome). Prompt recognition and management are critical due to the risk of neurodevelopmental impairment.

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🩺 Paediatric Plan of Management – Concern for Infantile Spasms (3-month-old)

1. Urgent Clinical Assessment

• Full history and examination, focusing on:

  • Description of spasms: clusters, flexor/extensor, occurring on waking

  • Developmental regression or plateau

  • Perinatal and family history

  • Neurological signs or syndromic features

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2. Urgent Neurology Referral

• Same-day referral to paediatric neurology is advised if infantile spasms are suspected.

• If unavailable locally, escalate via on-call paediatric neurologist or specialist epilepsy centre.

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3. EEG – Electroencephalogram

• Urgent EEG (ideally within 24–48 hours) to detect:

  • Hypsarrhythmia, typical of infantile spasms

• If EEG confirms diagnosis → initiate treatment without delay.

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4. Neuroimaging

• MRI brain (with contrast) to assess for:

  • Structural abnormalities (e.g., tuberous sclerosis, cortical dysplasia, hypoxic-ischemic injury)

• To be arranged after EEG, ideally within 1–2 weeks.

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5. Initial Laboratory Work-up

To identify underlying causes and assess fitness for therapy:

• Metabolic screen (blood and urine)

• FBC, U&E, LFTs

• Lactate, ammonia

• TORCH screen (if infection suspected)

• Genetic testing if syndromic features or dysmorphism

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6. First-line Treatment

Start ASAP after diagnosis is confirmed:

• Hormonal therapy:

  • Prednisolone: 10 mg four times daily (initial dosing may vary by centre)

  • OR ACTH injections (as per local protocols)

• Consider Vigabatrin:

  • First-line if tuberous sclerosis is suspected or confirmed

Choice of treatment depends on cause, centre experience, and availability.

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7. Monitoring and Support

• Monitor for side effects of treatment (BP, glucose, infection)

• Developmental monitoring

• Arrange multidisciplinary input (neurology, developmental paediatrics, physiotherapy, etc.)

• Parental support and education on seizures and medication

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8. Follow-Up

• Neurology follow-up within 1–2 weeks of starting treatment

• Repeat EEG after 2–4 weeks to assess response

• Ongoing developmental assessments

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🚨 If high suspicion before EEG available:

• In consultation with neurology, consider initiating treatment empirically, especially if clear clinical spasms and developmental regression are observed.

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Let me know if you'd like this plan tailored into a clinic letter or referral note.