N/A.

A 22 month-old girl with a history of cryptogenic infantile spasms (previously treated with prednisolone and ACTH) presented to the emergency department following three episodes of rapid left arm jerking and head bobbing each lasting a few minutes. She did not have any infectious symptoms and all workup was unremarkable with the exception of a positive COVID-19 PCR test. Prior to presenting to the hospital, she had been spasm free for over 14 months and was making good developmental progress. EEG showed modified hypsarrhythmia, abundant bifrontally-predominant spike and wave complexes, frequent bursts of generalized paroxysmal fast activity and frequent epileptic spasms up to 20 times per day. Given her COVID-19 status and recurrence after ACTH, the decision was made to proceed with Vigabatrin therapy resulting in full resolution of spasms, though no improvement in EEG background.

There are many factors associated with relapse of infantile spasms including: younger age of onset, delayed diagnosis and time to treatment, the presence of epileptiform discharges, and poor overall development. Viral infections are known to worsen epileptic seizures, however, infantile spasms have been shown to be less susceptible to viruses and there have been case series of spasm resolution following viral infections.  It is possible that this child’s spasms were an expected relapse and that COVID-19 infection was an incidental finding. However, she previously had a sustained response to therapy with neurodevelopmental improvement. As the number of children with COVID-19 increases worldwide, clinicians should consider testing for COVID-19 when a child presents with a relapse of previously well-controlled seizures.