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Risk of vigabatrin-associated brain abnormalities on MRI: A retrospective and controlled study
1Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
Objective:
Vigabatrin (VGB) is the first-line treatment for infantile spasms (IS). Previous studies have shown that VGB exposure may cause vigabatrin-associated brain abnormalities on magnetic resonance imaging (MRI) (VABAM). Based on previous studies, this study aimed to go further to explore the possible risk factors and the incidence of VABAM. In addition, diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) were compared to explore whether DWI should be used as a routine examination sequence when MRI is performed in children receiving VGB.
Methods:
Children with IS receiving VGB were selected as the study subjects. Whether VABAM occurred or not was categorized as the VABAM group and the non-VABAM group, respectively. Their general clinical data and medication exposure were collected. The possible risk factors of VABAM and different MRI sequences were compared and statistically analyzed.
Results:
A total of 77 children with IS were enrolled in the study, of which 25 (32.5%) developed VABAM. Twenty-three of the 25 VABAM cases have a peak dosage of VGB between 50 and 150 mg/kg/day. The earliest observation time of VABAM was 30 days. Regression analysis of relevant risk factors showed that the peak dosage of VGB was the risk factor for VABAM. Comparison between different MRI sequences showed that DWI is more sensitive than T2WI to the evaluation of VABAM.
Significance:
In our study, the occurrence of VABAM was 32.5%, indicating a higher incidence than in most previous reports. In addition, we once again verified that the peak dosage of VGB was the risk factor of VABAM. Caution should be exercised that our data also suggest that VABAM may occur even using the conventional dosage of VGB (ie, 50-150 mg/kg/day). Therefore, even when using the conventional dosage of VGB, regular MRI examination should be required. Furthermore, DWI sequence should be used as a routine examination sequence when MRI is performed in children with IS who are receiving VGB.
Insights
Vigabatrin (VGB) treatment for infantile spasms (IS) can cause brain abnormalities (VABAM) in 32.5% of children, particularly at higher doses. Diffusion-weighted imaging (DWI) is more sensitive for detecting VABAM than T2-weighted imaging (T2WI).
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Pharmacology
Background:
- Vigabatrin (VGB) is a primary treatment for infantile spasms (IS).
- VGB exposure is linked to vigabatrin-associated brain abnormalities on MRI (VABAM).
- Previous research indicates VABAM risk, but incidence and risk factors require further exploration.
Purpose of the Study:
- To determine the incidence and risk factors of VABAM in children with IS treated with VGB.
- To compare the sensitivity of diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) for VABAM detection.
- To assess the necessity of routine MRI screening and DWI in VGB-treated children.
Main Methods:
- Seventy-seven children with IS receiving VGB were retrospectively analyzed.
- Patients were categorized into VABAM and non-VABAM groups based on MRI findings.
- Clinical data, VGB dosage, and MRI sequences (DWI and T2WI) were compared.
Main Results:
- VABAM occurred in 32.5% of the 77 children studied.
- Peak VGB dosage between 50-150 mg/kg/day was identified as a significant risk factor for VABAM.
- DWI demonstrated higher sensitivity in evaluating VABAM compared to T2WI.
Conclusions:
- The incidence of VABAM is higher than previously reported, occurring even with conventional VGB dosages.
- Regular MRI monitoring, including DWI, is recommended for all children receiving VGB for IS.
- DWI should be incorporated as a routine MRI sequence for early VABAM detection.
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