Urfianty, Irawan Mangunatmadja
OBJECTIVE: Infantile spasms have unique seizure type, which may be characterized by flexor, extensor, and mixed flexor-extensor spasm, typically, the spasms involve brief and bilaterally symmetrical of the muscle contraction (neck, trunk and extremities), lasting up to 5 s, and frequently occur in cluster. This study aimed to report a case of infantile spasms in a eleven-months-aged girl. CASE: A 11-months-old girl was admitted to neurology outpatient ward with main complaint of recurrent seizures without accompanying fever since 1 month. It was sudden, rapid, tonic contraction of trunk and limb. He was born spontaneously by midwife, no active resuscitation with body weight 2600 gram. From neurologic examination normocephaly, clonus was found, elevated physiologic reflexes and without any cranial nerve nor motoric paralysis. Electroencephalography revealed supression-burst. Patient was diagnosed with infantile spasm and treated with valproic acid 20 mg/kg/day and treated with prednisone with dose of 2 mg/kg/day for two months. Dose of valproic acid has been increased because seizures were not significantly controlled. Antiepileptic drugs combination was also added because of the intractable seizure. Final antiepileptic drugs were valproic acid and levetiracetam. Overall, the seizures were controlled. Conclusion. Infantile spasms generally had a poor prognosis, especially if onset of spasms younger than 4 months, seizure before spasms and delayed response to the treatment. Survivors may develop psychomotor impairment. Nevertheless, with symptoms and suppression-burst from electroencephalography, we concluded this is an infantile spasm. Antiepileptic drugs combination corticosteroid are expected to control the seizure in this patient.