From the Guidelines
Children require a Hemoccult test when starting medications for infantile spasms because certain treatments can cause gastrointestinal irritation and bleeding, and early detection is crucial to prevent morbidity and mortality. When initiating medications like adrenocorticotropic hormone (ACTH) and oral steroids, such as prednisolone, for infantile spasms, healthcare providers must consider the potential risks of gastrointestinal side effects, including bleeding and ulceration 1. The medical evaluation before starting pharmacotherapy, as outlined in the practice parameter on the use of psychotropic medication in children and adolescents, emphasizes the importance of assessing the child's medical history and considering targeted medical testing to establish a baseline before initiating medications with known risks 1. Key points to consider in this context include:
- The potential for gastrointestinal irritation and bleeding with certain medications, such as ACTH and oral steroids
- The importance of early detection of occult blood in the stool to prevent severe complications
- The use of hemoccult testing as a standard monitoring protocol when initiating powerful anti-seizure treatments
- The possible need for gastric protection medications or dose adjustments if gastrointestinal injury is detected. Given the potential risks associated with these medications, healthcare providers should prioritize hemoccult testing to ensure the safety and well-being of children starting treatment for infantile spasms, as this approach aligns with the principle of completing a medical evaluation to minimize risk before initiating pharmacotherapy 1.
From the FDA Drug Label
WARNINGS AND PRECAUTIONS ... Anemia: Monitor for symptoms of anemia ( 5.7)
The FDA drug label does not answer the question.
From the Research
Background on Infantile Spasms
- Infantile spasms are a unique and severe form of epilepsy associated with poor neurologic and developmental outcomes 2.
- The primary goal of treatment is rapid and complete control of spasms 2.
Treatment Options for Infantile Spasms
- Several treatment options are available, including synthetic adrenocorticotropic hormone (ACTH), repository corticotropin injection (RCI/Acthar Gel), corticosteroids, valproic acid, vigabatrin, and surgery 3.
- Vigabatrin is an effective treatment for infantile spasms, particularly in cases related to tuberous sclerosis 4, 5.
Hemoccult (Fecal Occult Blood Test) Requirement
- There is no direct evidence in the provided studies to explain why children require a Hemoccult (fecal occult blood test) when starting medications for infantile spasms.
- However, it is possible that the test is required to monitor for potential side effects of certain medications, such as gastrointestinal bleeding, although this is not explicitly stated in the provided studies.