Long-term survival and factors associated with mortality among children with infantile epileptic spasms syndrome – A retrospective cohort study.

• Mortality among Indian children with infantile epileptic spasms syndrome seems to be comparable with developed countries. • The commonest cause of mortality observed among children with infantile epileptic spasms syndrome is sepsis. • Presence of seizures other than epileptic spasms is associated with lower survival time. • Presence of inborn error of metabolism as etiology is associated with lower survival time. • Children with idiopathic IESS have good survival prospects. The existing literature indicates a higher risk of mortality among children with Infantile epileptic spasms syndrome (IESS). Our aim was to find the mortality pattern and factors that affect survival among children with IESS. Children with IESS who had age of onset between one month and 24 months were included. The primary outcome was survival. We used Kaplan-Meier estimates for survival analysis and Cox regression analyses to evaluate possible factors associated with mortality. During the follow-up period (120 months), 19/160 children (11.9%) expired. Three children expired in the first week after initiation of ACTH. There were six deaths (3.8%; 31.6% of deaths), within two years. Clinical findings and laboratory investigations revealed the cause of death to be severe pneumonia in ten children. Three died of severe sepsis. Four died due to metabolic crisis and two children died due to probable Sudden unexpected death in epilepsy (SUDEP). On multivariable analysis, mortality was predicted by 'presence of seizures other than spasms' and an inborn error of metabolism (IEM) as the underlying cause. None of the children in the idiopathic group died. Survival in our single center cohort with IESS was good in comparison to previous studies. Considering that pneumonia and sepsis were the most common cause of mortality that we detected, steps for prevention of sepsis might be worth considering in these children. Presence of seizures other than epileptic spasms, and an IEM should prompt the physician to let the family know that risk of mortality is high. [ABSTRACT FROM AUTHOR]