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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Cerebral MRI abnormalities associated with vigabatrin therapy.
Phillip L Pearl1, Louis G Vezina, Russell P Saneto
1Department of Neurology, Children's National Medical Center, Washington DC, USA.
Epilepsia
|September 12, 2008
Summary
Vigabatrin therapy can cause new, reversible MRI abnormalities in young children, particularly in the brainstem and basal ganglia. These changes, seen on T2-weighted and diffusion-weighted imaging, resolve after stopping the medication.
Area of Science:
- Neurology
- Radiology
- Pediatric Epilepsy
Background:
- Vigabatrin is an antiepileptic drug used to treat infantile spasms.
- Magnetic Resonance Imaging (MRI) is crucial for diagnosing and monitoring neurological conditions.
- Previous reports suggested potential neuroimaging changes associated with vigabatrin therapy.
Purpose of the Study:
- To investigate new-onset and reversible T2-weighted MRI abnormalities in patients treated with vigabatrin.
- To identify specific brain regions affected by vigabatrin-related MRI changes.
- To compare MRI findings in vigabatrin-treated patients with those not receiving the drug.
Main Methods:
- Retrospective review of MRI scans from patients undergoing vigabatrin therapy.
- Assessment of patient demographics, diagnosis, vigabatrin dosage, duration of treatment, and concomitant medications.
- Comparison of MRI findings with a control group of patients with infantile spasms not treated with vigabatrin.
- Inclusion of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) map analysis.
Main Results:
- New and reversible T2-weighted hyperintensities were detected in 7 of 22 (32%) vigabatrin-treated patients, affecting basal ganglia, thalamus, brainstem, or dentate nucleus.
- All identified abnormalities resolved after discontinuing vigabatrin.
- Diffusion-weighted imaging showed restricted diffusion in affected areas.
- Younger age (median 11 months), longer therapy duration (3 months), and higher dosage (170 mg/kg/day) were associated with abnormalities.
- No similar abnormalities were observed in 56 control patients with infantile spasms.
Conclusions:
- MRI abnormalities, including reversible T2-weighted hyperintensities and restricted diffusion, are attributable to vigabatrin in a subset of patients.
- Affected brain regions include thalami, globus pallidus, dentate nuclei, brainstem, and corpus callosum.
- Young age and higher vigabatrin dosage are identified as risk factors for these neuroimaging changes.
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