A Clinical Audit to Improve Compliance with Evidence-Based Management in Infantile Epileptic Spasm Syndrome (IESS) at a Tertiary Care Center

Background: Infantile epileptic spasm syndrome (IESS) is a neurological emergency requiring early treatment and timely reassessment to optimize outcomes. Delays in follow-up after initiation of therapy are associated with persistent seizures, poor neurodevelopment, and progression to severe epileptic encephalopathies such as Lennox–Gastaut syndrome. Compliance with recommended early clinical and electroencephalography (EEG) reassessment remains a challenge in routine practice. Objective: To achieve > 90% compliance with clinical and EEG reassessment within 14 ± 2 days of adrenocorticotropic hormone (ACTH) initiation over 1 year. Methods: This ambispective audit was conducted in a tertiary care pediatric neurology center in three phases: baseline audit, intervention, and reaudit. Children diagnosed with IESS and initiated on ACTH were included. Compliance was defined as completion of both clinical and EEG reassessment within 14 ± 2 days. Baseline analysis identified barriers at system, provider, and caregiver levels. Targeted interventions included predischarge scheduling of EEG and outpatient visits, structured caregiver counseling emphasizing urgency, educational pamphlets, and improved multidisciplinary coordination. Postintervention compliance was reassessed. Results: Baseline compliance was 55%. Following intervention, compliance improved to 82%. The interventions were associated with improved follow-up rates and enabled earlier identification of nonresponders, facilitating timely treatment escalation. Conclusion: Simple, structured interventions significantly improved adherence to evidence-based reassessment timelines in IESS. Although the target of > 90% compliance was not achieved, substantial improvement was observed. Sustained gains will require continuous monitoring, reinforcement strategies, and system-level support. This audit highlights the effectiveness of quality improvement initiatives in enhancing adherence to guidelines and potentially improving long-term neurodevelopmental outcomes in children with IESS. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India