Clinical and Therapeutic Strategies for West Syndrome in Low‐Resource Settings: A 10‐Year Experience From Cameroon

Abstract

AIM: This retrospective cohort study reviewed medical records of 84 children diagnosed with infantile epileptic spasm syndrome (IESS) between 2015 and 2024 at the Douala Gyneco-Obstetric and Pediatric Hospital. Patients were invited for follow-up clinical assessment, with 67 children (79.8%) completing follow-up evaluations under a child neurologist's supervision. METHODS: The study reviewed medical records and conducted follow-up examinations. Data on socio-demographic, clinical and therapeutic features were analysed using SPSS 30.0. RESULTS: The prevalence of IESS was 0.34%, with mean symptom onset at 6.73 ± 4.02 months. The most common presentation was epileptic spasms (77.4%), predominantly flexion type (73%). Median diagnostic delay was 2.0 months (IQR: 1-3 months), with 65.5% of families initially seeking traditional medicine. The primary etiologies were perinatal asphyxia (64.3%), cerebral malformations (11.9%) and prematurity-associated brain injury (8.3%). Notably, 72.6% of infants had documented neonatal infections, which may have contributed to the pathophysiology in conjunction with other etiological factors. Electroencephalography revealed hypsarrhythmia in 97.6% of cases. Corticosteroids were the most frequent treatment (78.6%). Outcomes were poor, with high mortality (25.4%) and persistent developmental delays (90.0%). INTERPRETATION: The high mortality and developmental delays highlight the need for urgent interventions in low-resource settings, including: early diagnostic algorithms, discouraging delays due to traditional medicine, improving neonatal infection control, ensuring corticosteroid availability and implementing paediatric neurology teleconsultation to improve outcomes.