Risk of vigabatrin‐associated brain abnormalities on MRI in the treatment of infantile spasms is dose‐dependent

• DOI: 10.1111/epi.13712
• Publication Date: 2017-02-23T12:32:43Z
• Authors: Shaun A. Hussain; Jackie Tsao; Menglu Li; Madeline D. Schwarz; Raymond Zhou; Joyce Y. Wu; Noriko Salamon; Raman Sankar
• Keywords: Vigabatrin; Epileptic spasms; Hypsarrhythmia

Summary Objective Although the link between vigabatrin ( VGB ) and retinotoxicity is well known, little attention has been focused on risk of ‐associated brain abnormalities magnetic resonance imaging MRI VABAM ), namely reversible—and largely asymptomatic—signal changes in thalami, basal ganglia, brainstem tegmentum, cerebellar nuclei. Using a large infantile spasms cohort, we set out to identify predictors these phenomena. Methods Children with were retrospectively identified. Brain reports serially reviewed without knowledge exposure. Upon discovery, records systematically ascertain presence symptoms attributable . Separately, progress notes sequentially quantify Results We identified 507 studies among 257 patients spasms. treatment was documented 143 children, detailed exposure data available for 104, whom 45 had at least one study during treatment. Among limited subset asymptomatic children who underwent (n = 40), 6 exhibited Risk dose‐dependent, as peak (but not cumulative) dosage strongly associated (p 0.0028). In an exploratory analysis, encountered 4 symptomatic 104 data. seemingly dose‐independent, potentially concomitant hormonal therapy (i.e., prednisolone adrenocorticotropic hormone [ ACTH ]) 0.039). Significance have demonstrated dose‐dependent uncovered possible association therapy. Caution should be exercised use high >175 mg/kg/day), further warranted confirm potential impact