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Clinical profile and treatment of infantile spasms using vigabatrin and ACTH--a developing country perspective
Shahnaz Ibrahim1, Shamshad Gulab, Sidra Ishaque
1Medical College, The Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
Insights
Vigabatrin and ACTH showed similar initial effectiveness for infantile spasms. However, Vigabatrin is suggested as the first-choice treatment due to a lower relapse rate compared to ACTH.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pharmacology
Background:
- Infantile spasms (IS) are a severe epileptic syndrome in early childhood.
- Adrenocorticotropic hormone (ACTH) and Vigabatrin are key treatments for IS.
- This study compares the efficacy of ACTH and Vigabatrin in Pakistani patients with IS.
Purpose of the Study:
- To compare the efficacy and relapse rates of ACTH and Vigabatrin in infantile spasms.
- To identify optimal first-line therapy for infantile spasms in a developing country context.
Main Methods:
- A retrospective study of 56 patients with infantile spasms at Aga Khan University Hospital (2006-2008).
- Inclusion criteria: clinical IS, hypsarrhythmia/modified hypsarrhythmia on EEG, >=6 months follow-up, treated with ACTH or Vigabatrin.
- Random drug distribution based on availability, cost, and administration ease.
Main Results:
- Initial treatment response was similar: 50% for ACTH and 55.3% for Vigabatrin.
- Relapse rates were higher with ACTH (55.5%) versus Vigabatrin (33.3%) in first-line therapy.
- Symptomatic and idiopathic IS groups showed better response to Vigabatrin.
Conclusions:
- No significant difference in initial efficacy between ACTH and Vigabatrin for infantile spasms.
- Vigabatrin is associated with a lower relapse rate than ACTH monotherapy.
- Vigabatrin is recommended as the initial drug of choice for infantile spasms, pending further research in developing countries.
Background:
Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of patients with infantile spasms from Pakistan.
Methods:
All patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned above. The type of drug distribution was random according to the availability, cost and ease of administration.
Results:
Fifty six cases fulfilled the inclusion criteria. 62.5% were males. Mean age at onset of seizures was 5 +/- 1.4 months. Fifty two (92.8%) patients demonstrated hypsarrythmia on electroencephalography. 64.3% cases were identified as symptomatic while 19.6% were cryptogenic and 16.1% were idiopathic. Eighteen patients received ACTH while 38 patients received Vigabatrin as first line therapy. Initial response to first line therapy was similar (50% for ACTH and 55.3% for Vigabatrin). Overall, the symptomatic and idiopathic groups responded better to Vigabatrin. The relapse rate was higher for ACTH as compared to Vigabatrin (55.5% vs. 33.3%) when considering the first line therapy. Four patients evolved to Lennox-Gastaut variant; all of these patients had initially received Vigabatrin and then ACTH.
Conclusion:
Vigabatrin and ACTH showed no significant difference in the initial treatment of infantile spasms. However, patients receiving ACTH were 1.2 times more likely to relapse as compared to the patients receiving Vigabatrin when considering monotherapy. We suggest that Vigabatrin should be the initial drug of choice in patients presenting with infantile spasms. However, larger studies from developing countries are required to validate the therapeutic trends observed in this study.
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