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Vigabatrin for infantile spasms
Wendy G Mitchell1, Namrata S Shah
1Neurology Division, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA.
Insights
Vigabatrin effectively treats infantile spasms in infants. Starting with a low dose and gradually increasing is more advantageous than a high initial dose, as response appears dose-independent.
Area of Science:
- Pediatric Neurology
- Pharmacology
Background:
- Infantile spasms are a severe epilepsy syndrome in infants.
- Vigabatrin is an antiepileptic drug used to treat infantile spasms.
Purpose of the Study:
- To evaluate the efficacy and optimal dosing strategy of vigabatrin for infantile spasms in a cohort of 20 infants.
Main Methods:
- Retrospective review of 20 infants treated with vigabatrin for infantile spasms.
- Dosing initiated at 125-250 mg/day, gradually increased to a target of 100 mg/kg/day.
- Video electroencephalogram (EEG) used to assess spasm cessation and hypsarrhythmia resolution.
Main Results:
- Twelve out of 20 infants (60%) responded with cessation of spasms and hypsarrhythmia resolution.
- Responses were observed at doses ranging from 25-135 mg/kg/day (median 58 mg/kg/day).
- Six infants showed partial responses, and two had no response; three developed new seizure types.
Conclusions:
- Vigabatrin is an effective and well-tolerated treatment for infantile spasms.
- Response to vigabatrin appears to be dose-independent.
- Initiating treatment with a low, gradually increasing dose is recommended over a fixed high initial dose.
Abstract:
We reviewed 20 infants receiving vigabatrin for infantile spasms. Patients were not enrolled in a formal study. All families obtained the medication abroad. Age at initiation of vigabatrin ranged from 1 to 48 months; nine infants had received prior treatment with various antiepileptic medications. Patients were begun on the lowest practical dose of 125-250 mg/day, with gradual daily increments to a target of 100 mg/kg/day, but maintained at the lowest effective dosage. Video electroencephalogram was obtained to document resolution of spasms and hypsarrhythmia. Of 20 infants, 12 responded with cessation of spasms and resolution of hypsarrhythmia, at doses of 25-135 mg/kg/day (median = 58 mg/kg/day). Partial responses were observed in six patients, whereas two had no response at 111 and 125 mg/kg/day. Additional new seizure types developed in three infants after initial response to vigabatrin. Increasing the vigabatrin did not have any clinical benefit. Vigabatrin is an effective, well-tolerated treatment for infantile spasms. The response is dose-independent, suggesting that starting at a low dose and gradually increasing, rather than beginning with an arbitrary 100 mg/kg/day dose is advantageous.