sandifer's syndrome vs infantile spasmssandifer's syndrome vs infantile spasms

Michaud JL, Lachance M, Hamdan FF, Carmant L, Lortie A, Diadori P, Major P, Meijer IA, Lemyre E, Cossette P, Mefford HC, Rouleau GA, Rossignol E. The genetic landscape of infantile spasms. Bruckheimer E, Goldberg M, Lernau O. Sandifer's syndrome reported and reviewed. A particular cause will be found in 7 or 8 out of every 10 children with West syndrome. Symptoms are most common after your baby eats when the contents of their stomach dont settle. Expensive and comprehensive neurologic examination may be unnecessary. All children with infantile spasms will need an EEG. The children had unremarkable neurologic examinations with normal findings. Care coordination includes coordination between general pediatricians, pediatric neurologists, nurses, pharmacists, and therapists. Babies with the condition will often experience clusters of . Infantile spasms (IS) is a seizure disorder that was first described by William West in 1841 and has been referred to as West syndrome. Infantile spasms (IS) are a type of seizure that is linked to an epileptic condition known as West syndrome. Brunson KL, Khan N, Eghbal-Ahmadi M, Baram TZ. [13]ACTH is thought to work by suppression of corticotropin-releasing hormone that in animal models was found to be an endogenous neuropeptide that provoked convulsions. This quick movement is similar to how you pull your hand away from a hot surface to avoid burning your hand. (2017). [41]Further testing must be performed if clinical suspicion is high for IS. [23]Associated with the spasms include motor arrest, lasting up to 90 seconds, as well as rhythmic nystagmoid eye movements or eye deviation. Review. - Torque extremities movements. They also improve gastric emptying and reduce reflux volume. Your message has been successfully sent to your colleague. With continued research regarding infantile spasm and its etiologies, pathogenesis, diagnosis, and treatment the overall prognosis of IS is poor. Please try after some time. Additional symptoms that can happen as a result of Sandifer syndrome include: The exact cause of Sandifer syndrome is unknown. Moseley BD, Nickels K, Wirrell EC. The triad of spasms, arrest of psychomotor development . Efficacy and safety of histamine-2 receptor antagonists. Sandifer syndrome is a temporary condition that usually goes away or clears up by the time your baby reaches one year old. [9]The patients with IS who do not have an identifiable cause after the above thorough evaluation will be classified in the grouping of cryptogenic IS which, as above, encompasses 10% to 40% of those with IS. The spasms are tiny seizures that can have a big impact on a baby's development. Treating Sandifer syndrome involves trying to reduce symptoms of GERD. Satoh J, Mizutani T, Morimatsu Y. Neuropathology of the brainstem in age-dependent epileptic encephalopathy--especially of cases with infantile spasms. Ranitidine, cimetidine, famotidine, and nizatidine have been commonly used but their biggest reported drawback is tachyphylaxis.1 Although histamine2-receptor antagonists are widely used, a systematic literature review of efficacy and safety showed little evidence to justify their use and recommended they be used with caution.21, PPIs inhibit acid secretion by blocking the H+K+ATPase pump in the gastric parietal cell, keeping gastric pH above 4 for longer periods of time, and inhibiting meal-induced acid dump. Because of the complex nature of infantile spasms and the need for prompt diagnosis and initiation of treatment, strict interprofessional communication must occur. There are two ways to do that: dietary changes or taking medications. Acid reflux: This is when stomach acid journey to your esophagus and throat and causes pain . While you cant prevent all causes of the condition, you can do the following to reduce your babys risk of developing Sandifer syndrome: If your baby has gastroesophageal reflux disease, follow your providers recommended treatment plan to make sure your babys symptoms improve and that they get the nutrients they need to stay healthy. showed that involuntary abdominal contrac- episode lasting for 20-30 s. These movements were observed tions trigger a reex leading to a head tilt. The seizures occur in a series of short spasms, about one to two seconds in length. We report the case of a 5-month-old infant with no past medical history admitted to a pediatric unit for suspicion of infantile spasms. [37]Vigabatrin dosing is initiated at 50 mg/kg per day; dosing can be escalated to 100 to 50 mg/kg per day if required. Are there side effects to the anti-reflux medications? Infantile spasms (West syndrome): update and resources for pediatricians and providers to share with parents. This is associated with developmental regression. Human brain GABA levels rise rapidly after initiation of vigabatrin therapy. Both of those things are outgrown without intervention. Clinical signs may also include anaemia. This activity reviews the cause, presentation, and diagnosis of infantile spasms and highlights the role of the interprofessional team in its management. Tests might include: Managing GERD is the key to treating Sandifer syndrome. American Academy of Neurology. It is quite rare, only 1% of babies with The author noted that in two patients who did not have successful surgical control of the reflux, the posturing did not stop.8. This syndrome was first mentioned more than 50 years ago with minimal documentation in the medical literature. Symptomatic IS is described in patients with an identified etiology and/or significant developmental delay at the time of spasm onset.[1]The identified etiologyis found in 60% to 70% of symptomatic IS cases. Sandifer syndrome is a condition that causes your baby to have uncontrollable muscle spasms after they eat. Watanabe K. West syndrome: etiological and prognostic aspects. Sandifer's investigations found that the children and adolescents had disorders of the upper gastrointestinal (GI) tract, particularly hiatal hernia. Children (GERD) International Journal of. Infantile spasms syndrome is considered an epileptic encephalopathy, conditions in which children have both seizures and cognitive and developmental impairments. Specific features identified were a preponderance of acquired structural aetiology, male gender dominance, a long treatment lag . Some infants diagnosed with Sandifer syndrome have an allergy to proteins in cows milk or certain types of formulas, which can make their symptoms worse. Infantile spasms, also called West Syndrome, is an early life epilepsy that affects children in the first two years of life during a period of rapid brain development. Early diagnosis is critical, as treatment is simple and leads to prompt resolution of the movement disorder. Because of the presentation, the patient may be referred for lengthy, expensive, and unnecessary neurologic testing. A proposal for case definitions and outcome measures in studies of infantile spasms and West syndrome: consensus statement of the West Delphi group. History & Examination History and exam Key diagnostic factors presence of risk factors spasms head nodding neurodevelopmental delay or regression More key diagnostic factors Other diagnostic factors As stated above infantile spasms "are characterized by epileptic spasms with onset in infancy or early childhood that are usually associated with the EEG pattern of hypsarrhythmia, and also developmental regression. It is a disorder that affects mostly those in the first year of life and is described as spasms with characteristic EEG changes known as hypsarrhythmia and a strong association with developmental delay or regression. Once diagnostic testing is completedthepatient should begin treatment without delay. Both of these can lead to GERD. Furthermore, when the hiatal hernia and acid reflux were surgically corrected, the posturing stopped.5, Fewer than 1% of children with GERD also have Sandifer syndrome (Figure 1).4 Researchers theorize that many patients with the syndrome may not be recognized because it is mistaken for a neuromuscular or neuropsychiatric disease.4 Many of these children get extensive unnecessary neurologic evaluations and treatments.4,6 Sandifer syndrome is thought to be an underreported condition in literature but is believed to be seen frequently in the pediatric neurology and gastroenterology settings.4, Kotagal and colleagues reviewed 6 years of data from the Cleveland Clinic's pediatric epilepsy monitoring unit to determine the frequency and source of paroxysmal nonepileptic events.7 They found that in children ages 2 months to 5 years being evaluated for paroxysmal nonepileptic events, 16% had GERD as the underlying diagnosis.7, History and clinical observation are fundamental in identifying Sandifer syndrome as part of the atypical presentation of GERD.6 Typically the infant may exhibit irritability, crying, eye deviation with head version, torticollis that may change sides, extensor spasm, dystonic posture (Figure 2), and rumination (rechewing of regurgitated food product).2,6, Torticollis associated with Sandifer syndrome is unique. Lightdale JR, Gremse DA, et al. Moore, Debora M. MPAS, PA-C; Rizzolo, Denise PA-C, PhD. Misdiagnosis as benign infantile spasms or epileptic seizures is common, particularly where clear signs or symptoms of gastro-oesophageal reflux are not apparent. During their feeding and right after, its important that your baby sits upright, or someone holds them in an upright position, to help prevent food from coming back up. The Centers for Disease Control and Prevention has released updated recommendations on its childhood vaccination schedule. Direct observation of the patient is beneficial. The seizures (or spasms) make muscles in the arms and legs stiff and bend the baby's head forward. We avoid using tertiary references. 10. The International League Against Epilepsy has proposed the term "infantile epileptic spasms syndrome (IESS . Not a Member? Gremse DA. Characteristics include: Epileptic spasms Developmental problems Infant reflux: Overview. The first stage is noted to be relatively mild with infrequent and isolated spasms. Infantile spasms: criteria for an animal model. Eighty-seven percent of surgical patients who had a hiatal hernia responded to surgery and the symptoms of Sandifer syndrome resolved. This should be pursued ifsuspected.[28]. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. 19. Winter HS. . Orenstein SR, McGowan JD. modify the keyword list to augment your search. The probe might require an overnight hospital stay. Emergency medical physicians may also be part of care coordination as they will likely evaluate the patient initiallywhen the parents note spasms. WEST SYNDROME Dr.Dhritiman Choudhury Tripura medical college 2. introduction West syndrome is a severe epilepsy syndrome composed of the triad of infantile spasms, an interictal electroencephalogram (EEG) pattern termed hypsarrhythmia, and mental retardation, although the diagnosis can be made even if 1 of the 3 elements is missing (according to international classification) 17. AAPA Members can view Full text articles for FREE. Discussions regarding the possibility of neurodevelopmental delay, seizures, and mortality must occur. 9 The neurobehavioral posturing may be mistaken for seizures, fits, or infantile spasm. [35]Other alternative treatment are available for initial treatment of IS. For more information, please refer to our Privacy Policy. Stafstrom CE, Holmes GL. [1]Also, spasms typically occur in the waking state or the daytime. What age does Sandifer syndrome start? Caring for patients with infantile spasms is complex and requires extensive interprofessional communication to improve patient outcomes. Infantile spasms and West syndrome, like many other epilepsy syndromes, have lots of different causes. Infantile spasm, sometimes known as West Syndrome, is a very rare form of childhood epilepsy. [17][18]Additional pathogenesis stems from the origin of epileptic spasms which primarily occur in the cerebral hemispheres or the brainstem. CNS Malformations: The most common central nervous system (CNS) malformation to occur in the prenatal period, accounting for 30% of cases, iscorticaldysplasia. Evidence-based guideline update: medical treatment of infantile spasms. Go CY, Mackay MT, Weiss SK, Stephens D, Adams-Webber T, Ashwal S, Snead OC., Child Neurology Society. One theory in the pathophysiology of IS is that IS results from a nonspecific insult at a critical point in the ontogenetic development of the brain.[16]Another is that abnormalities in the hypothalamic-pituitary-adrenal axis, due to immunologic dysfunction or stress from variable causes in early development may contribute to the pathogenesis of IS; this theorywas developed from the responsiveness of IS to adrenocorticotropic hormone (ACTH) treatment as will be discussed later. Ataxia Telangiectasia. 20. Gaily E, Liukkonen E, Paetau R, Rekola R, Granstrm ML. The differential diagnosis for infantile spasm is broad including mild diagnoses such as colic, gastroesophageal reflux, spasticity, benign neonatal sleep myoclonus, or excessive startles or Moro reflexes up to more severe diagnosis. Cleveland Clinic Children's is dedicated to the medical, surgical and rehabilitative care of infants, children and adolescents. Vigabatrin is a GABA-transaminase inhibitor, this allows for increased GABA in the CNS. Gastro-Esophageal Reflux in Children. Some studiesdetermine a slightly higher rate of males compared to females being affected with a ratio of 60:40. [22]Lastly, as described in the definition of IS, neurodevelopmental delay with regression of motor and cognitive abilities occurs. What type of thickener should I use to thicken breast milk/formula? Surgical treatment is another consideration for refractory IS if a focal-cortical structural, metabolic abnormality or neurodevelopmental arrest/regression is noted. - Swing and rotation of the head. Sandifer syndrome was first recorded in the early 1960s, and the exact number of cases is unknown. 4 There are a few reports in adults. Episodes of physiologic reflux usually are short and infrequent, may help decompress the stomach after meals, and should not cause long-term complications.9,12 Primary reflux is associated with a disorder of the lower esophageal sphincter; pressure causes the sphincter to relax and let gastric contents backflow into the esophagus. However, its almost always related to a problem with the lower esophagus, which leads into the stomach, or a hiatal hernia. Our website services, content, and products are for informational purposes only. The children without hiatal hernia who required surgery had a response rate of 100% to surgical correction. Children diagnosed with Sandifers Syndrome will quite often grow out of it by 18-36mths, unless the child has severe mental impairment or similar conditions, in which case the child may continue to have spasms into adolescence. Molecular Sciences. Koo B, Hwang P. Localization of focal cortical lesions influences age of onset of infantile spasms. If Sandifer syndrome is diagnosed, parents can be reassured the posturing will likely improve with treatment. [1][2][3] There is a significant correlation between the syndrome and gastro-oesophageal reflux disease (GORD); however, it is estimated to occur in less than 1% of children with reflux. Infantile epileptic encephalopathy with hypsarrhythmia (infantile spasms/West syndrome). At first our ped diagnosed our kid with Sandifer syndrome because he had reflux and paroxysmal torticolis (alterning sides torticolis). My comments are related to the new terminology of Infantile Spasms Syndrome in place of previously used West syndrome. 6 Sandifer syndrome differs from epileptic events in that it lacks the rhythmic clonic component. 9. We do not endorse non-Cleveland Clinic products or services. Parents may also note the loss of social interactions, social smiles, or increased fussiness or silence. Each premiseissupported by autopsy studies as well as neuroimaging, EEG findings, and neurotransmitter abnormalities. - Spasms last between 1 and 3 minutes and can occur up to 10 times on the same day. Babies with infantile spasms commonly have mental and developmental problems. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) At this time as there is only probable effectiveness of corticosteroids the optimal preparation, dosing and duration has not been established. Infantile spasms need to be treated as quickly as possible. Infantile spasms is a unique epileptic disorder characterized by clusters of brief infantile spasms, where each one lasts a few seconds and cluster may last minutes. to maintaining your privacy and will not share your personal information without Search for Similar Articles The condition can cause temporary muscle spasms as a reaction to acid reflux. Dulac O, Soufflet C, Chiron C, Kaminska A. Sandifer Syndrome by Dr Hamza Alsayouf Consultant Pediatric Neurologist: Episode 9. In children, GERD usually goes away on its own after theyre about 18 months old, when the muscles of their esophagus mature. "[1]As the name indicates 90% of children affected by IS present at less than one year of age with a peak incidence of 3 to 7 months. Up to 15% of prenatal causes of ISare attributedto chromosome abnormalities including 18q duplication, 7q duplication, deletion of MAGI2 gene on chromosome 7q11.23-q21.11, and partial 2p trisomy. Kabakuş N, et al. Infantile spasms last around one to two seconds in a series; whereas other types of seizures can last from 30 seconds to two minutes. Specific features identified were a preponderance of acquired structural aetiology, male gender dominance, a long treatment lag, limited availability of adrenocorticotropic hormone . [27]In some cases of IS, there are diffuse structural brain diseases with no focal or lateralizing features on imaging studies that can be identified with positron emission tomography. Your babys provider will help you identify how often and how much your baby should take in each day. Babies also might have slowed development or loss of skills (like babbling, sitting, or crawling). [1][13]The epidemiology of IS has been established, but the pathophysiology of the disease is evolving. [25][26]The characteristic EEG finding to diagnose IS is a pattern known as hypsarrhythmia. 12. [4], The classical symptoms of the syndrome are spasmodic torticollis and dystonia. However, a study by since2weeksofage.Hehad 10-12 episodes per day, each Frankel et al. The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet. [27], After an EEG shows findings suggestive of IS, neuroimaging is the next diagnostic test that should be pursued. Sandifer syndrome. Genetic and Rare Diseases Information Center. Secondary reflux is due to disease or a condition in the upper GI tract, such as idiopathic pyloric hypertrophy or esophagitis from cow's milk protein, or outside the GI tract, such as intracranial hypertension.9, GERD denotes the presence of damage from the increase in frequency and intensity of reflux.12 In infants and children, GERD can cause respiratory symptoms, failure to thrive, esophagitis, anemia, apparent life-threatening events such as apnea and choking, and paroxysmal nonepileptic events.1,7,9,12 Signs of GERD in infants and children can include irritability, feeding refusal, rumination, and fussiness.9. Infantile spasms: a pathophysiological hypothesis. 6. 10 . Neurological examination is usually normal. Gastroesophageal reflux: management guidance for the pediatrician. Kids Neuro Clinic and Rehab Center Dubai 2.7K views 2 years ago Lovely Moments When Babies Fart - WE LAUGH We. ( Badriul H, Vandenplas Y. Gastro-oesophageal reflux in infancy. [1], In regards to comparison to ACTH, vigabatrin is inferior to ACTH when assessing short-term outcomes. There is a peculiar epidemiological profile of IESS in South Asia. Infantile spasms were described first by West in 1841 [ 1 ]. Rasmussen's syndrome typically appears in children who are between 14 months and 14 years of age. MalaCards based summary: Sandifer Syndrome, also known as sandifer's syndrome, is related to gastroesophageal reflux and torticollis, and has symptoms including torticollis Affiliated tissues include eye and breast, and related phenotypes are gastroesophageal reflux and torticollis Phenylketonuriais the most common inborn error of metabolism with etiological associations with IS in countries where PKUis not identified at birth; this accounts for 12% of patients with PKU. It is a disorder that affects mostly those in the first year of life and is described as spasms with characteristic EEG changes known as hypsarrhythmia and a strong association with developmental delay or regression. (2015). If changes to your babys diet dont work, your provider may recommend treatment with anti-reflux medications, including: After anti-reflux medications start, you should notice your babys symptoms decrease over time and resolve. Arachnoid Cysts. The main symptoms of Sandifer syndrome are torticollis and dystonia. Genetic Mutations: In addition tochromosomal abnormalities genetic mutations such as those encoding the forkhead protein G1,syntaxin-binding protein 1, calcium/calmodulin-dependent serine protein kinase, ALG13, pyridoxamine-5-phosphate oxidase, andadenylosuccinatelyase havebeen identifiedtobe associatedwith IS. The first line treatment for IS is hormonal therapy with corticotropin, ACTH. The most common neurocutaneous disorder to be associatedwith infantile spasms and accounting for 10% to 30% of prenatal causes is tuberous sclerosis complex (TSC) in which 68% of patients will have IS. Tests arent usually necessary, but they can rule out conditions with similar symptoms to confirm a diagnosis. Czinn SJ, Blanchard S. Gastroesophageal reflux disease in neonates and infants: when and how to treat. To monitor the effectiveness of treatment one most record the complete cessation of spasms with a repeat EEG that shows resolution of hypsarrhythmia. Clinicians should have a high index of suspicion for Sandifer syndrome when a child presents with intermittent torticollis or atypical posturing in the absence of injury or disease. Those were the alternate 2 diagoses that my pediatrician gave me. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Hrachovy RA, Frost JD, Kellaway P, Zion TE. Torticollis refers to involuntary movements of the neck. Find out more about treating acid reflux in infants. Mandel H, Tirosh E, Berant M. Sandifer syndrome reconsidered. Cryptogenic IS has no identifiable causeand the following criteria: no other kind of seizures, a normal examination, a normal CT and MRI, recurrence of hypsarrhythmia between consecutive spasms of a cluster, and lack of any focal interictal or ictal EEG abnormalities. Infantile spasms represent an age-specific epileptic disorder of infancy and early childhood. Comorbid & Secondary Conditions Additional seizure types are seen in 30 to 50% of infants with this syndrome. Get new journal Tables of Contents sent right to your email inbox, www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-gastroesophageal-reflux-disease-in-children-and-adolescents, Articles in PubMed by Debora M. Moore, MPAS, PA-C, Articles in Google Scholar by Debora M. Moore, MPAS, PA-C, Other articles in this journal by Debora M. Moore, MPAS, PA-C, Plantar fasciitis: A review of treatments, Physician assistant postgraduate education, Hyperkalemia and potential pitfalls of sodium polystyrene sulfonate, The changing physician assistant profession: A gender shift, Privacy Policy (Updated December 15, 2022). We report the case of a 5-month-old infant with no past medical history admitted to a pediatric unit for suspicion of infantile spasms. [1]Infantile spasms have been evaluatedfor over 170 yearsin regards to etiology, pathogenesis, clinical features, and diagnosis. Spasms and hypsarrhythmia can directly contribute to cognitive and behavioral impairments. Baram TZ, Mitchell WG, Tournay A, Snead OC, Hanson RA, Horton EJ. The Neurologist suggest Sandifer's Syndrome and has referred us back to Ped. Its also important to burp your baby during and right after feeding to bring up any air they may have swallowed. The diagnosis and management of gastro-oesophageal reflux in infants. Wheless JW, Gibson PA, Rosbeck KL, Hardin M, O'Dell C, Whittemore V, Pellock JM. Child Neurology Society. Ohtahara S, Ohtsuka Y, Yamatogi Y, Oka E, Yoshinaga H, Sato M. Prenatal etiologies of West syndrome. Babies can have . Exercise and Childhood Obesity: How Effective Are School-Based Physical Activity Programs? Quick recognition of the subtle presentation of Sandifer syndrome can lead to a timely diagnosis, treatment, and near-universal resolution of this troubling condition. In these situations, breastfeeding (chestfeeding) parents may have to change their diets or use a different formula as your babys provider recommends. Sandifer syndrome - About the Disease - Genetic and Rare Diseases Information Center National Center for Advancing Translational Sciences Browse by Disease About GARD Contact Us We recently launched the new GARD website and are still developing specific pages. The spectrum of nonepileptic events in children. Cerebral dysgenesis, lissencephaly,holoprosencephaly, andhemimegalencephalyaccount for theadditionalCNS malformations that can be associated withIS. An additional subgroup of cryptogenic proposed by the International League Against Epilepsy (ILAE)is known as idiopathic infantile spasm.[1][2]. Weakness and other neurological problems often begin 1 to 3 years after the seizures start. Sandifer syndrome is a rare complication of gastroesophageal reflux disease that may be more common than reported. your express consent. Burp your baby during and right after feeding. The important features and the importance of early diagnosis and treatment are discussed below. Arteriovenous Malformations (AVMs) Ataxia and Cerebellar or Spinocerebellar Degeneration. Sandifer syndrome is a rare condition affecting infants and children upto the age of 2 years (24 months). Hodgeman RM, Kapur K, Paris A, Marti C, Can A, Kimia A, Loddenkemper T, Bergin A, Poduri A, Libenson M, Lamb N, Jafarpour S, Harini C. Effectiveness of once-daily high-dose ACTH for infantile spasms. This may lead to a missed or delayed diagnosis, mismanagement, and the use of inappropriate medication. Gordon N. Sandifer's syndrome: investigations and treatment. Smith MS, Matthews R, Mukherji P. Infantile Spasms. Hayk S Arakelyan. Earn Category I CME Credit by reading both CME articles in this issue, reviewing the post-test, then taking the online test at http://cme.aapa.org. This page is currently unavailable. Mortality rates of IS range from 3% to 33%. More accurately, it is a response to severe pain caused by the presence of stomach acid in the oesophagus. What are the reasons for the strikingly different approaches to the use of ACTH in infants with West syndrome? Sandifer syndrome is uncommon and clinically presents with a sudden onset of transient, spasmodic torsional dystonia with arching of the back and opisthotonic posturing (positioning of the head and heels backward and the spine arching forward, with intermittent torticollis) in patients with GERD or hiatal hernia.1,2 The movements associated with this disorder are disturbing to parents and can perplex clinicians because the presentation can mimic seizures.3 However, prompt recognition and treatment will quickly resolve the disorder. 5,6 Patients may present with episodes of torticollis, 7,8 laterocollis, 9 or retrocollis. Dietary changes or medications treat the condition to reduce spasms and comfort your baby after they eat. This can help your childs doctor see if there are any patterns, which can make diagnosing Sandifer syndrome easier. Treatment of Sandifer syndrome with an amino-acid-based formula. Corticotropin (ACTH) acts directly on amygdala neurons to down-regulate corticotropin-releasing hormone gene expression. Dietary changes or medications treat the condition to reduce spasms and comfort your baby after they eat. This pattern comprises very high voltage, random, slow waves and spikes in all cortical areas.[13]Spikes may occur in a generalized manner but are never rhythmic or organized as would beseen in childhood absence epilepsy. Attention Deficit Hyperactivity Disorder. Infantile spasms (IS) are a type of seizure, and are the most common severe epilepsy in infants IS are typically sudden, brief, bilateral and symmetric contraction of the muscles of the neck, trunk and extremities, occurring in clusters IS are often the presenting feature of a significant underlying neurological disorder

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