Response to treatment and outcomes of infantile spasms in Down syndrome.

This was a retrospective chart review, so treatment assignment and outcome recording were not controlled. Medication choice, dose, and timing varied by centre and clinician, so response rates may reflect local practice rather than the medication itself. Developmental outcomes were subjective clinician reports, not standardized tests, and children with Down syndrome already have variable development. Only six children received first-line prednisolone plus vigabatrin, so the 83% response rate is too small to guide treatment. Fifty-four children met the criteria, but long-term outcome percentages are based on 52 children with follow-up because two died unrelated to spasms. Neuroimaging was not standardized and was performed in 78% (42 children), so imaging findings may not apply to all children. The study reported outcomes in one group of children with Down syndrome and infantile spasms, so it cannot show how much spasms or treatment changed development.

Do not read the 83% spasm cessation after first-line prednisolone and vigabatrin as evidence the combination should be preferred. Only six children received it, and three had side effects, so the result is too small to guide treatment.