Ann Child Neurol.  2020 Jul;28(3):88-92. 10.26815/acn.2020.00059.

Short Course and Early Switch of Vigabatrin for Infantile spasms

Affiliations
  • 1Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
  • 2Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea
  • 4Department of Pediatrics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea

Abstract

Purpose
Vigabatrin has proven efficacy in the treatment of infantile spasms, but it carries the risk of irreversible visual field constriction. The incidence of vigabatrin-induced visual field constriction seems to depend on the extent of vigabatrin exposure. The aim of this study was to evaluate whether the therapeutic effect of vigabatrin is maintained in patients with infantile spasms receiving a short vigabatrin course followed by switching to another antiepileptic drug.
Methods
Patients with infantile spasms responsive to initial vigabatrin treatment were divided into a vigabatrin switch group (n=25) and a vigabatrin maintenance group (n=41). In the former group, vigabatrin was switched to other drugs within 6 months of spasm remission. The rate of seizure recurrence at 6 and 12 months from spasm remission was compared between the two groups.
Results
No statistically significant differences were found between the vigabatrin switch and maintenance groups in the age of onset, presence of concomitant seizures, time from spasm onset to vigabatrin treatment, time from vigabatrin treatment initiation to spasm remission, or vigabatrin dose at spasm remission. The number of patients with seizure recurrence at 12 months after spasm remission was 3 (3/25, 12%) in the vigabatrin switch group and 10 (10/41, 24.4%) in the vigabatrin maintenance group. The seizure recurrence rate at 12 months from spasm remission was not significantly different between groups. A short course of vigabatrin could be considered in patients with infantile spasms who are responsive to initial vigabatrin treatment, since spasm remission was maintained after switching to other drugs.

Keyword

Spasms, infantile; Vigabatrin; Visual field constriction
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