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What is the treatment for West syndrome?

Q: My nephew is seven months old. He is a caesarean baby and his birth weight was 2.5 kg. On the fourth day after his birth, he had a convulsion along with hypoglycaemia for which he was admitted in the ICU. But since he was six months of age, he started having frequent seizures. We consulted a doctor who suggested an EEG and a MRI of his brain. The MRI report found the evidence of cortical thinning and hyperintense signal on T2 WI, FLAIR and IR involving bilateral occipital poles. The underlying white matter shows hyperintense signal on FLAIR. The MRI report suggests the possibility of sequelae of perinatal hypoxic-ischaemic damage. The EEG report suggests abnormal sleep EEG suggestive of epileptic encephalopathy. Accordingly, the doctor prescribed the following medicines: Topirol 25 (one tablet twice daily), Lonazep 0.25 (one-fourth of the tablet thrice daily)and Benadon 40 (one tablet twice daily). Also, the doctor advised physiotherapy. He was diagnosed with West syndrome (symptomatic). After taking the above medications he was alright for a few days. However, the bouts of seizures have started reappearing since the last 2-3 days. We consulted the doctor and he added Predone forte syrup (to be taken once) to the above-mentioned medicines. But he is still having seizures. Can you please let me know the whether the above ailment is curable? Can he lead a normal life?

A:Symptomatic infantile spasms (West syndrome) is a severe form of childhood epilepsy which presents around 3-6 months of age. It is a difficult epilepsy to control and only 25% of children reach normalcy. Your neurologist seems to be treating it in the correct manner. He will probably have to increase the doses or substitute another drug if his fits are not controlled. Do carry out occupational therapy and intervention there. You will need to be patient, as medicines can be increased or substituted gradually. I would suggest you have a frank talk with your neurologist, and he will apprise you the problems you are going to face.


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