P55 – 3034: Iron deficiency anaemia and infantile spasms

Abstract

Objectives An established aetiology remains unknown in a substantial proportion of infantile spasms (IS). The possibility that nutritional factors play a role in the timing of presentation or outcome of this epilepsy, with its typically encephalopathic onset, has received little attention, although vitamin B12 deficiency without macrocytic anaemia has been reported. We undertook an audit of our IS cases to determine if there was any evidence of anaemia and/or iron deficiency. Methods We reviewed the available haematology for IS cases with hypsarrythmia on electroencephalography over a 5 year period. Haemoglobin, Haematocrit and Mean Cell Volume (MCV) were compared to age specific values by calculating the standard deviation (Z) score. Results Fifteen children were retrieved (11 boys; median age 13 months at treatment for IS). Previously recognised aetiologies included Down syndrome, septo-optic dysplasia & tuberous sclerosis; MRI was abnormal in 12. Eight (53%) had red cell indices consistent with anaemia and/or iron deficiency anaemia at presentation with z scores for Haemoglobin (n=6) and/or Haematocrit (n=7) less than 2 standard deviations below the age specific mean. Serum ferritin was available in 10 with values of 2, 3, 5, 18, 18, 24, 27, 34, 36 and 97μg/L, with the lower limit of normal for our laboratory being 18 μg/L. There was no association between iron deficiency and EEG features, e.g. presence of focal abnormalities as well as hypsarrythmia. Conclusions Half of the consecutive children presenting with IS had red cell indices and/or ferritins consistent with anaemia or iron deficiency. Iron deficiency in infancy is a well-recognised risk factor for developmental delay, which should be excluded and treated in children with infantile spasms. Further research is required on the strength of any association between iron deficiency and infantile spasms and the biological basis for any aetiological link or effect on outcome.