LOW DOSE VIGABATRIN FOR THE TREATMENT OF INFANTILE SPASMS

Objectives: Management of infantile spasms is difficult because current treatment regimens, including many anticonvulsants and hormone, are often ineffective and the side effects are serious. We conducted this study to test the effective minimal dose of vigabatrin (VGB) as add-on therapy in patients with infantile spasms.

Methods: Three patients with infantile spasms were given VGB as add-on therapy with initial dose of 250mg/d, after failure of treatment with high dose pyridoxal phosphate (600mg/d) and topiramate (11–25mg/kg/d). The VGB dose was raised by 250mg/day every 2 days. Subjects were monitored by admission for 2 weeks and followed by weekly visits. Long term video-electroencephalogram was done in every subject. Side effects were recorded. The visual fields of the patients were followed by neuro-ophthalmologist.

Results: There were 2 boys and 1 girl (body weight 8.1 to 10kg), aged from 8 months to 10 months. The etiology of infantile spasms was cryptogenic in 1 and symptomatic in 2 with periventricular leukomalacia and shaken baby syndrome, respectively. Hypsarrhythmia were noted in 3 patients. Follow-up electroencephalogram showed disappearance of hypsarrhythmia in all 3 patients. The infantile spasms of 3 patients were all controlled by add-on therapy of low dose VGB (31–55mg/kg/day). No newly visual problems were defined by neuroophthalmologist.

Conclusion: Add-on therapy with low dose VGB combined with high dose topiramate for the treatment of infantile spasms is effective. Side effect of visual problem might be reduced by low dose VGB. The results are promising and justify more trials with low dose VGB in larger numbers of children with infantile spasms.