VIGABATRIN MONOTHERAPY AS FIRST LINE IN INFANTILE SPASMS - A STUDY OF70 NURSING INFANTS

Background. - Steroids (hydrocortisone or ACTH) still remain the usual treatment for infantile spasms (IS). However, since 1990 some authors have reported the efficacy of vigabatrin (VGB) especially in cases re lated to tuberous sclerosis. Population and methods, - Seventy childre n with infantile spasms were treated by VGB first line monotherapy. Mo dalities of treatment and monitoring were the same for all children. V GB was given at the daily dose of 100 mg/kg during 1 week. If spasms p ersisted, the daily VGB dose was increased to 150 mg/kg during a 2nd w eek. In case of persistence of IS, on the 15th day, hydrocortisone was then added to VGB. Of the 70 infants, 39 were symptomatic and 31 cryp togenic. Results. - On VGB, 37 children (54%) stopped having IS within a mean 3.5 days. Response to VGB was different according to etiology. Among cryptogenic cases, 22 infants (71%) definitively stopped having spasms and only one relapsed. Among symptomatic cases, only 15 infant s (38%) stopped having IS, and half (8/15) relapsed. VGB mean daily do se at cessation of spasms was 114 mg/kg. Side effects were transient d rowsiness (27%) and agitation (12%). Mean follow-up was 10 months (1-2 4 months). Seventy-five percent of the infants presenting with a focus of spike after the Ist month of treatment relapsed. Conclusion - Infa nts with cryptogenic spasms have a good response to VGB monotherapy. W hen mental retardation is noticed before IS, and MRI is normal, there is no efficacy. In these cases, the best treatment seems to be prolong ed corticotherapy associated with WE. (C) 1998, Elsevier, Paris.