Clinic Letter

*Final Report*
Date of Visit: 05/17/2006

Medication: Vigabatrin 500 mg tablet, half a tablet in the a.m. and one table in the evening sine last three months (18mg/kg per day)

Medication Tried: Topamax and Klonopin

Allergies: No known drug allergies

Interval History: D is a 9 month old boy who came to the Neurology clinic for follow-up of infantile spasms.

Full-term normal delivery. Birth weight 5 pounds 8 ounces. NO history of admission in the NICU. Seizure onset at 4 1/2 months of age. It started with infantile spasms. He was getting 10-12 clusters a day and each cluster consisted of approximately 15 spasms. The second day after starting the Vigabatrin he stopped having seizures. He was started on 250 mg b.i.d. A month later it was increased to 250 mg in the a.m. and 500 mg int eh evening because off and on he was having dilation of his pupils without any behavioral arrest. The parents have not seen any spasms. His last spasm was 02/14/06, second day after starting Vigabatrin.

He is gaining skills. He has started holding the head better. He started eating solids baby food, sitting up, smiling, laughing, tracking and recognizing people.

He is getting OT and PT 3 days a week. He is also involved in the Early Intervention.

His behavior is good, He is interacting, Sleep is good.

He was seen by an ophthalmologist and his next appointment will be the end of this month.

Past Medical and Surgical History: Infantile Spasms and Developmental delay

Family History: He is the only son of his father. He has four half siblings. Family history is significant for seizures in mom's brother and mom's niece.

Developmental History: He is 9 months old. He can sit with support and babbles. He is interacting.

On Examination: Today his weight is 9.3 kg, height 71.5 cm, heart rate 97 per minute and regular, and blood pressure 100/57. Heart S1 and S2 are heard. Lungs are clinically clear. Abdomen is soft, no mass. Bowel sounds are present. He had a small head, but he is falling sometime. He has no other dysmorphic features. No neurocutaneous stigmata.

Neurological Exam: He is alert, interactive. Pupils are 2mm in size, reacting to light equally on both sides. Visual acuity is good. Field of vision is normal. Fundus is normal. Extraocular movements are normal. No facial asymmetry. Tongue and uvula in center. He has mild drooling of the saliva.

He has generalized hypotonia. Deep tendon reflexes are 2+. No ankle clonus.

Investigations Done: His MRI done on 02/09/2006 showed polymicrogyria with evidence of cortical dysplasia predominately in perisylvian distribution. VMR done on 04/24/2006 for one day showed the background is slow for age. Some segments of the sleep showed hypsarrhythmia. One cluster of habitual events was captured with the EEG showing diffuse seizure onset.

Impression: D is a 9 month baby boy with a falling problem.
1. Brain malformation/bilateral perisylvian syndrome.
2. Infantile Spasms