Infantile spasms and developmental epileptic encephalopathy — clinical case

A six-month-old boy is referred for two weeks of sudden flexor spasms that occur in clusters on waking, each lasting one to two seconds and recurring up to 40 times per cluster, captured on a parent's phone video. His mother reports that over the same two weeks he has stopped smiling responsively and no longer babbles. His interictal examination is normal apart from lost social and language milestones. A sleep EEG shows a chaotic, high-voltage pattern with random, asynchronous slow waves of more than 200 microvolts, multifocal spikes, and no recognisable background. A brain MRI shows a focal area of cortical dysplasia in the left frontal region. There are no hypomelanotic macules on Wood's lamp examination.