Neuropediatrics 2006; 37 - THP73
DOI: 10.1055/s-2006-945896

THE USE OF VIGABATRIN AND SYNACTHEN IN THE TREATMENT OF INFANTILE SPASMS

A Birca 1
  • 1CPEN Study Group on Infantile Spasms, Ste-Justine Hospital, Montreal, QC, Canada

Objectives: The goal of this paper is to describe the response of Infantile Spasms to vigabatrin and the every other day steroid, synacthen in a prospective cohort. This is part of a larger double-blind study looking at improving the cognitive outcome of spasms with neuroprotective agents. Methods: Children presenting at one of the seven participating university hospitals with previously untreated spasms were included in this protocol. They received vigabatrin for 14 days and if they did not have a complete clinical and EEG response with both arrest of spasms and disappearance of hypsarrhythmia, they were switched to synacthen every other day for 12 weeks. EEG, seizure diary and adverse events were reviewed at 2, 4 and 24 weeks.

Results: We have included up to now 51 children between the ages of 3 and 15 months. These included 54% of symptomatic, 35% cryptogenic and 11% idiopathic spasms. The average diagnosis delay was 1.04 months. 61% responded to vigabatrin as the first intention drug and 96% responded when both drugs were required leaving only 2 patients with refractory spasms. This regimen was well tolerated with no children discontinuing vigabatrin and only one stopping synacthen due to myocardiopathy.

Conclusion: Vigabatrin as the first intention followed by synacthen is an efficacious and well-tolerated protocol. Whether this will improve cognitive outcome remains to be assessed.