HOUSTON – The types of diagnostic tests ordered and medication used for treatment of infantile spasms vary considerably, a large study of children’s hospitals showed.
“Children with infantile spasms often require extensive diagnostic work-up to determine etiology, expensive medications for treatment, and hospitalization during the initiation of certain therapies,” researchers led by Sunita N. Misra, MD, PhD, wrote in an abstract presented at the annual meeting of the American Epilepsy Society. “The common diagnostic studies and therapies have evolved over the last several decades.”
Doug Brunk/Frontline Medical News
Dr. Sunita N. Misra
The researchers collected patient demographics, hospital length of stay, hospital admission cost, use of various diagnostic studies (such as lumbar puncture, brain MRI, and EEG), and medications used for infantile spasms (including antiepileptic drugs, corticotropin, and steroids). Cost data, calculated as a ratio of cost to charges, were collected and adjusted to 2014 dollars.
A total of 6,183 patients were included in the analysis and their average age of infantile-spasm diagnosis was 9 months. The most common diagnostic test ordered was EEG (76%), followed by brain imaging (57%), organic acids (38%), and lumbar puncture (17%). Medications were started during inpatient hospitalization in two-thirds of patients, with 33% starting on corticotropin; 29% on topiramate; and fewer than 10% of patients on an oral or intravenous steroid, zonisamide, or vigabatrin (Sabril). Use of corticotropin decreased over time, while use of oral steroids trended upwards. “We were surprised that one-third of patients did not have a medication initiated as an inpatient, given the studies showing earlier use of effective therapy has better outcomes,” Dr. Misra said in an interview in advance of the meeting.
“The cost of taking care of children with infantile spasms has increased over the study period 2004-2014,” Dr. Misra said. “Although we identified a few contributors to rising cost, there are probably other factors that need to be considered in future studies.” She acknowledged certain limitations of the analysis, including its retrospective design and the fact that it only identified cost associated with the initial admission. “Several of the diagnostic studies and medications may be initiated as an outpatient, for which we do not have the data,” she said.
Dr. Misra reported having no financial disclosures.