Introduction: Epileptic spasms (ES) are brief tonic jerks of proximal/truncal muscles seen in infants and young children. In resource-limited countries, it presents a challenge due to the high incidence of birth asphyxia, late presentation, and limited treatment options. This study aimed to describe the treatment and neurological outcomes of cases seen at Komfo Anokye Teaching Hospital (KATH) over a 5-year period.

Methods: We reviewed the electronic records of children diagnosed with ES at KATH between Jan-2018 and Aug-2023. Data retrieved included demography, developmental profile, EEG findings, underlying causes, treatment, and outcomes. The data was exported to Microsoft Excel and analysed.

Results: Sixty-two cases were enrolled (median age 8 months at presentation, males 59.7%). At presentation, 88.7% had developmental delay/regression. Common underlying causes were birth asphyxia (62.9%), structural abnormalities (8.1%), neonatal seizures (6.5%), and prematurity (4.5%). Electroencephalogram (EEG) data was available for 44 patients, with 75.0% showing hypsarrhythmia or suppression-burst pattern. Initial treatment comprised of prednisolone only (48.38%), prednisolone and vigabatrin (35.4%), or prednisolone, vigabatrin, and ACTH (4.8%). In 37.1%, spasms resolved completely, 19.4% had some improvement, and 19.4% had spasms recurring after initial resolution. There was no improvement in 11.3%. In the long-term, 46.8% developed cerebral palsy with 21% evolving into other seizure types. Almost half of the cases were lost to follow-up.

Conclusions: Birth asphyxia is the most common underlying cause of ES in children at KATH. Steroids are the mainstay of treatment with mixed neurological outcomes. Early referral and prompt treatment are recommended for improved outcomes.

Perpetua Kanzie

Senior Resident

Department of Child Health

Komfo Anokye Teaching Hospital

Kumasi, Ghana

Patience Kwawu

Senior Resident

Department of Child Health

Komfo Anokye Teaching Hospital

Kumasi, Ghana

Charles K. Hammond

Consultant Paediatric Neurologist

Department of Child Health

Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology

Kumasi, Ghana