Infantile spasms:-West syndrome Onset : 3-8 months of life Characterised by combination of salaam spells( sudden dropping of the head and flexion of arms), developmental retardation, hypsarrythmia on ECG.Causes-Hypoxic ischemic encephalopathy Neurocutaneous syndromes Perinatal infections Hemorrhage Injury Metabolic disorders Localized structural malformations  The spasms occur in clusters usually on wakingDrug therapy-Intramuscular ACTH 40-60 unit per day may be given 4-6 weeks and tgen tapered off. On the other hand oral prednisolone at 2 mg/ kg / day in divided doses may also be used. These agents abolish spasms and may result in resolution of hypsarrythmia.