Thus, she was treated with Sodium valproate at a dose of 30 mg/kg/day and hydrocortisone at a dose

of 2 mg/kg/day and her seizures disappeared immediately. Thereafter, hydrocortisone was stopped after 3 months and sodium valproate was continued at the same dose. At long-term, valproate therapy was effective with good seizure control but her psychomotor development was severely impaired. After a follow-up of 7 years, the patient presents growth retardation, microcephaly, severe psychomotor development delay, generalized RG7204 concentration hypotonia, tetraparesis and epilepsy well controlled by sodium valproate. Down syndrome is the most common genetic cause of mental retardation with a reported prevalence find more of epilepsy of 6.4–8.1%. Infantile spasms or West syndrome is the most frequent epilepsy syndrome in children with Down syndrome. West syndrome occurs in 0.6–13% of children with Down syndrome, representing 12.8–32% of seizures in these children [2] and [7]. The mechanisms that raise susceptibility to infantile spasms in patients with Down syndrome have yet to be thoroughly uncovered. However,

several authors suggest a potential epileptogenic role for the interaction of various Down syndrome-specific structural abnormalities of the brain, such as lower rates of inhibitory interneurons, decreased neuronal density, abnormal neuronal lamination, persistence of dendrites with fetal morphology, primitive synaptic profiles or altered membrane potassium permeability [1] and [2]. The diagnosis of West syndrome is often easy when the infantile spasms are associated with arrest or regression of psychomotor development, and a specific EEG pattern of hypsarrhythmia [1] and [5]. The clinical symptoms

of infantile spasms are very different than any other type of seizure because of the absence of paroxysmal motor phenomena, such as convulsions or loss of consciousness. This lack of more typical of seizure phenomena Phospholipase D1 may lead to initial misdiagnosis of infantile spasms by pediatricians at the first medical consultation. Recently, it was reported that approximately one third of infants with infantile spasms were not suspected of having epilepsy during the first medical consultation [9] and [10]. Infantile spasms in infants are usually symmetrical and manifested by a repetitive flexor, extensor or flexor–extensor spasms with sudden and brief axial contraction, predominating in the upper limbs, with upper deviation of the eyes [11]. It is estimated that approximately 60–90% of children with West syndrome have an associated with a brain abnormality such as brain injury or cortical and subcortical malformations of the brain due to abnormal development, present in isolation or associated with other diseases such as Down syndrome [8] and [12]. The magnetic resonance imaging is required to study the brain with great precision and detect brain malformations in some children [12].