Treatment of infantile spasms: results of a population-based study with vigabatrin as the first drug for spasms.
OBJECTIVE
The efficacy of a protocol consisting of vigabatrin (VGB) as the first and adrenocorticotropic hormone (ACTH) or valproate (VPA) as the second drug was studied in the treatment of newly diagnosed infantile spasms (IS) during 1994 to 1997 in a population-based design.


METHODS
Only total disappearance of the spasms with a minimal duration of 1 month was accepted as a response. The treatment response was confirmed by video-EEG study. All infants were studied by magnetic resonance imaging (MRI) or computed tomography (CT) for etiology.


RESULTS
Altogether 42 infants, 10 with cryptogenic and 32 with symptomatic etiology, were treated. Eleven (26%) responded to VGB, five (50%) with cryptogenic, and six (19%) with symptomatic etiology; 91% of infants responded to a dose of 50-100 mg/kg/day, and 82% of them within 1 week. ACTH was offered in combination with VGB to 22 and VPA to four infants for whom VGB failed. Eleven responded to ACTH and one to VPA. In total, 26 (62%) infants responded to the treatment protocol; all (100%) with cryptogenic etiology and 16 (50%) with symptomatic etiology. ACTH treatment was associated with more severe side effects than VGB or VPA. Only one infant relapsed after a spasm-free period with VGB of >4 months, but none after ACTH was combined with VGB.


CONCLUSIONS
We suggest VGB as a first drug to all infants with IS. After a treatment trial of 10-14 days with increasing dose from 50 to 150 mg/kg, ACTH should be considered.
Epilepsy Unit, Hospital for Children and Adolescents, University of Helsinki, Finland.
M L
ML
Granström
E
E
Gaily
E
E
Liukkonen
D000612:4-Aminobutyrate Transaminase / Q000037:antagonists & inhibitors; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D001927:Brain Diseases / Q000175:diagnosis; D002648:Child; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000706:statistics & numerical data; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D013036:Spasms, Infantile / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use; D014743:Videotape Recording; D020888:Vigabatrin; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000927:Anticonvulsants; D005680:gamma-Aminobutyric Acid; D014635:Valproic Acid; D000324:Adrenocorticotropic Hormone; D000612:4-Aminobutyrate Transaminase; D020888:Vigabatrin