INTRODUCTION. West Syndrome involves epileptic encephalopathy in infants,
occurring with an incidence of 5/10000 live births. Its main clinical feature
are spasms that occur in clusters, which are associated with an EEG pattern
called hypsarrhythmia and psychomotor retardation in most patients. West
Syndrome is associated with many underlying conditions and the terms
idiopathic, cryptogenic, and symptomatic are used for its aetiological
subgroups. OBJECTIVE. The objective of this investigation was to determine
the aetiological diagnosis of patients with West Syndrome and to compare the
results with other studies. METHOD. In this 34-year longitudinal prospective
one-centre study, 404 patients were studied. All patients exhibiting the
diagnostic criteria for West Syndrome were investigated by clinical and
neurological examination, EEG, ophthalmologic, psychological, metabolic,
genetic, as well as neuroradiological methods, according to their particular
indications. RESULTS. 36 (8.9%) patients had normal development, in whom
infantile spasms occurred without any identifiable underlying cause, forming
the idiopathic group. 51 patients (12.6%) with neurological impairment of
unknown aetiology formed the cryptogenic group. The greatest number of
patients (317 or 78.5%) formed the symptomatic group, in which neurological
features and developmental delay preceded the onset of spasms. Disgenetic
disorders and hereditary metabolic diseases were aetiological factors 44
(10.8%) patients. Prenatal and perinatal aetiological factors were revealed
in one third of the patients (134 or 31%). Postnatal aetiological factors
were revealed in 42 (10.2%) patients. In our study, disgenetic disorders were
registered less frequently and perinatal complications more frequently than
in other studies. CONCLUSION. Our results indicate the possibility of
preventing West Syndrome with good quality obstetric and neonatal care, as
well as the early prenatal diagnosis of brain malformations. Modern,
sophisticated investigation makes the more accurate aetiological diagnosis of
West Syndrome possible.