VIGABATRIN AS INITIAL THERAPY FOR INFANTILE SPASMS - A EUROPEAN RETROSPECTIVE SURVEY

Purpose: The efficacy and tolerability of vigabatrin (VGB) as an add-o n therapy in the treatment of infantile spasm (IS) prompted physicians to explore its use as the first drug in this seizure type. Methods: O ur retrospective study included 250 infants diagnosed with IS; the dat a obtained were subjected to peer-group review. Of this infant populat ion, 192 infants were considered to have classic IS and had received V GB as their first treatment for the spasms. There was a slight prepond erance of boys (57%) in this population. Mean age of IS onset was 5.8 months; 60% had typical hypsarrhythmia. Results: Initial suppression o f spasms was obtained in 68% of infants with a median time to response of 4 days at an average VGB dose of 99 mg/kg/day. The best response w as seen in those infants with tuberous sclerosis (96% response) and in those younger than 3 months at onset of spasms (90% response). Of the se infants, 43 (22%) of 192 subsequently had other types of seizures, and a recurrence of infantile spasms occurred in 28 (21%) of 131 respo nders. At the end of this study, 96 of 192 infants who could be evalua ted were seizure free with VGB monotherapy. Treatment appeared to be w ell tolerated, with only 33 (13%) infants with adverse events, of whic h the most common were somnolence (15 patients) and hyperkinesia (eigh t patients). In only two cases did adverse events require VGB withdraw al. Conclusion: This study supports the opinion that VGB may be consid ered an initial treatment for IS regardless of cause.