When it comes to epilepsy, we typically tend to associate the disorder with seizures. While seizures are common symptoms experienced by people with epilepsy, there are other ways that the condition manifests itself, such as epileptic spasms.
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Epileptic spasms are a symptom of epilepsy that results in patients briefly jerking or tensing. These spasms are short, typically lasting for no longer than 2 seconds at a time. The most common time for babies to experience epileptic spasms is when they wake from sleep.
Epileptic spasms tend to repeat in a cluster fashion, with 1 to 2-second spasms repeating every 5 seconds or so for some time. Children with this condition can experience hundreds of seizures per day.
Epileptic spasms are also sometimes referred to as infantile spasms because they typically affect babies under one year.
Common symptoms of epileptic spasms include:
Stiffened and tensed muscles
Jackknife seizures (with the child’s body bending forward and knees pulling up, the head thrown back, and arms moving out to the side)
Eyes rolling up
Nodding of the head
Movement of the chin
There are multiple reasons why a baby might develop epileptic spasms. Unfortunately, though, sometimes the cause cannot be identified. The possible causes of epileptic spasms that we do know include the following:
Injury to the brain can result in the development of epileptic spasms. Injuries that result in a child’s brain not getting enough oxygen or blood, meningitis, and a specific type of fetal stroke during pregnancy, called perinatal stroke, can all contribute to the onset of spasms.
Fetal development of the brain and spinal cord is key to healthy functioning. When that development goes wrong, it can cause issues like epileptic spasms. These malformations can include cortical dysplasia, lissencephaly, Aicardi syndrome, and holoprosencephaly.
We now know that certain genetic mutations can lead to the development of epileptic spasms. Genetic conditions leading to spasms include Miller-Dieker syndrome, CDKL5 deficiency disorder, Down syndrome (trisomy 21), and tuberous sclerosis.
Your metabolism turns the food that you consume into energy. But when your metabolism goes haywire, it can result in the development of severe nutrition issues. Problems with your metabolism can, in some cases, lead to a vitamin B6 deficiency that causes epileptic spasms.
Standard anticonvulsant drugs (AEDs) are ineffective against epileptic spasms, so it can be challenging to manage the symptoms of this condition. Treatment options for epileptic spasms include:
Vigabatrin, a medication used in epilepsy management
Adrenocorticotropic hormone (ACTH), a hormone that is effective in reducing epileptic spasms¹
It’s important to note that researchers have a contentious debate about appropriate epileptic spasm treatment protocol.
And while current treatments show positive indications, robust data is lacking, and randomized and comparative trials are needed to understand their effectiveness further.
Treatment can effectively help to manage epileptic spasms, but there is no evidence that it can alter long-term outcomes.
Unfortunately, the underlying issues that are often behind the development of epileptic spasms predispose patients to poor development outcomes, such as the following:
Up to 50% of patients with epileptic spasms also suffer from epilepsy
15%–33% of patients with epileptic spasms also have autism
Up to 70% of patients with epileptic spasms also have tuberous sclerosis
Normal development occurs in only 15%–25% of patients with epileptic spasms
Better outcomes are seen in patients without an identified cause for their spasms. Even better developmental outcomes are seen in patients treated with hormonal therapy (ACTH) rather than vigabatrin.
Seizures result from electrical disturbances in the brain, resulting in the uncontrolled movements and behaviors we see in seizure patients. Seizures can affect patients of any age.
There are two main types of seizure classifications:
Partial seizures occur in only one hemisphere of your brain and can happen while conscious or unconscious.
The common symptoms of this type of seizure include involuntary twitching and muscle tensing, hallucinations, sweating, drooling, skin color change, and changes to the emotional state. Some patients also experience an aura before a partial seizure.
Generalized seizures occur in both hemispheres of the brain and can be classified into various types, including tonic, atonic, absence, and myoclonic seizures.
The treatment options for seizures will depend on the type of seizure a patient is experiencing and how often they occur. Treatment options for seizures include:
Medication options for patients experiencing seizures include anti-epileptic drugs (AEDs) such as carbamazepine, lacosamide, phenytoin, and oxcarbazepine. More recently approved medication options include the cannabinoid product Epidiolex.
Surgery can be effective in helping to manage seizures in patients who aren’t responding to medication. Surgery for seizures involves severing connections in the area of the brain where misfiring electrical activity is occurring.
You might be surprised to learn that diet can help manage seizures. The ketogenic, low glycemic index, and modified Atkins diets have all shown promise in reducing seizures.²
Implanting electrodes into certain brain areas and the vagus nerve (located in the neck) can help block seizures.
The main differences between epileptic spasms and seizures are:
Epileptic spasms typically occur within the first year of life, while seizures can develop at any age.
Epileptic spasms cause 2-second spasms that repeat every 5 seconds for some time. Seizures can result in symptoms ranging from violent jerking to small hand movements, staring spells, loss of consciousness, and many more.
The first-line treatment option for epilepsy is AEDs. Successful treatment options for epileptic spasms include hormone and steroid medications.
While seizures and epileptic spasms can share some visual similarities—both can produce jerking movements, muscle tension, and loss of focus—they are very different conditions.
An epileptic spasm looks like a brief jerking movement that lasts no longer than 2 seconds and typically repeats after 5 seconds for a short cluster. Children with epileptic spasms also tend to lose focus, roll their eyes up, grimace, throw their heads back, bend forward, pull their knees up, and move their arms out to the side.
Children are most likely to experience an epileptic/infantile spasm for the first time between the ages of 4 and 7 months. However, spasms can begin to show at any time during the child’s first few years. Most patients with epileptic spasms will be diagnosed within the first year of life.
Epileptic spasms tend to stop in patients by age 2 to 4 years old.
A spasm is a 2-second repeated jerking movement that typically affects infants just as they wake. Seizures are movements or behaviors (without pause) that occur due to electrical disturbances in the brain and can affect patients of any age.
Infantile spasms | National Institute of Neurological Disorders and Stroke
Infantile spasms | Bostons Children's Hospital
Infantile spasms | MSD Manual
Partial epilepsy (2022)
Seizure medications (2022)
Who can epilepsy surgery help? | Epilepsy Foundation
Infantile spasms (2022)
Infantile spasms west syndrome | Epilepsy Foundation