West syndrome (WS) is a severe form of epilepsy of early infancy. Its diagnosis, evaluation, and management continue to pose many challenges to health care professionals and affected families. It is a retrospective review of patients of West syndrome who were followed up at least 6 months after diagnosis. We followed up 70 infants with West syndrome. EEG change of each follow up was recorded. For each individual child, we selected minimum three visits in the follow up period. Visit 1 was defined as the visit when the treatment for infantile spasms was started. Visit 2 at day 14 of first visit, Visit 3 at 6 month of first visit. Clinical data on file were used for analysis. Hypsarrhythmia initially was recorded in 20 of total number of 70 patients (28.6%). Modified hypsarrhythmia was recorded in 40 infants (57%), multifocal discharges were found in 7 patients (10%). In third follow up at 6 month, first EEG showed a change of pattern with multifocal discharges in most of the cases (52.9%) while EEG was normal in 24.3% of cases. 30% of our patients were completely free from clinical seizures at 6 months with 67% of them having normal EEG pattern and 29% with multifocal discharges. Interictal EEG pattern changes with clinical course and with treatment. НLs is a retrospective study about the etiology and evolution of interictal EEG patterns of WS children referred to Department of Pediatric Neurology and Development of a tertiary care hospital conducted from January 2016 to February 2017. Seventy patients were selected, all having characteristic ES and developmental delay or regression at diagnosis. ES were LdentLfied as brief axial contractions occurring in clusters, observed by a trained pediatric neurologist and registered on EEG recording. Age of onset, seizure semiology, birth history, developmental history, family history, and treatment history was recorded. Etiologies were analyzed. Detailed clinical and neurological examination was done. MRI was the preferred neuroimaging suggested for the patients which was done in the first visit, however, CT scan was done in some patients due to finDncLDl constrain. Treatment was given as per protocol of the department. First line drug was injection of ACTH in non-Tuberous sclerosis (TS) patients and Vigabatrin in TS patients. If there was failure of first line drug, then subsequently Na Valproate, topiramate, levetiracetam, oral steroid, vigabatrin (if previously not used) were given. Pyridoxin was given in selected cases. Minimum three visits were selected when EEG was done. Visit 1 was defined as the visit when the treatment for infantile spasms was started. Visit 2 at day 14 of first visit, visit 3 at 6 month of first visit. Mean time of follow up was 11 months, lowest follow up was 6 months and longest follow up was 3 years. Hypsarrhythmia was characterized by an EEG with 0.5 to 3 Hz chaotic, asynchronous slow waves with voltages greater than 300 mV. Multifocal spikes and sharp and slow waves may also present. Intervals of attenuation can occur with and without clinical myoclonic activity or flexor spasms. 0odLfied hypsarrythmia was described by one of the following criteria: 1. Hypsarrhythmia with increased interhemispheric synchronization, 2. Asymmetrical hypsarrhythmia, 3. Hypsarrhythmia with a consistent focus of abnormal discharge, 4. Hypsarrhythmia with episodes of attenuation, and 5. Hypsarrhythmia comprising primarily high-voltage slow activity with little sharp-wave or spike activity. In conclusion our study revealed that symptomatic (now metabolicstructural) WS is still the most common form of WS in a recourse limited setting with perinatal asphyxia being the main cause. Most common form of EEG is modLfied hypasrrhythmia on diagnosis while in course of time a sLJnLficDnt number turns into multifocal discharges. While normalization of EEG in last visit was associated with freedom of seizure.