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In this episode, "Understanding Variability in Infantile Spasms Care," Christina Briscoe, MD, epileptologist at Boston Children’s Hospital, discusses new multi-center findings on current treatment practices for infantile epileptic spasms syndrome (IESS). Briscoe outlines why first- and second-line therapies remain largely standardized, yet significant variability emerges once hormonal therapy and vigabatrin fail. She details the evidence gaps driving inconsistent third-line and fourth-line decision-making, including limited clinical trial data, uneven access to ketogenic diet programs and epilepsy surgery, and historically low industry investment in infant-specific trials. Additional discussion focuses on ongoing research from the Pediatric Epilepsy Research Consortium, national and global comparisons in treatment pathways, barriers to study scalability in rare pediatric epilepsies, and the practical challenges of implementing timely diagnosis and standardized care across diverse healthcare settings. Briscoe also highlights under-recognized issues such as incorporation of ketogenic diet and early surgical evaluation into treatment pathways, and emphasizes the need for broader infrastructure, funding, and multi-center collaboration to improve outcomes for children with IESS.

Episode Breakdown:

1:05 – Origins of the study, need to pursue more standardized care in IESS

4:40 – Reasons behind treatment variability after first and second-line options

8:00 – What research is needed to guide sequencing and standardize care

12:05 – Neurology News Minute

14:30 – What makes IESS studies difficult and how infrastructure can improve

18:50 – Lesser-discussed gaps, including ketogenic diet and surgical evaluation

The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here:

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