Cerebral MRI abnormalities associated with vigabatrin therapy.
OBJECTIVE
Investigate whether patients on vigabatrin demonstrated new-onset and reversible T(2)-weighted magnetic resonance imaging (MRI) abnormalities.


METHODS
MRI of patients treated during vigabatrin therapy was reviewed, following detection of new basal ganglia, thalamus, and corpus callosum hyperintensities in an infant treated for infantile spasms. Patients were assessed for age at time of MRI, diagnosis, duration, and dose, MRI findings pre-, on, and postvigabatrin, concomitant medications, and clinical correlation. These findings were compared to MRI in patients with infantile spasms who did not receive vigabatrin.


RESULTS
Twenty-three patients were identified as having MRI during the course of vigabatrin therapy. After excluding the index case, we detected new and reversible basal ganglia, thalamic, brainstem, or dentate nucleus abnormalities in 7 of 22 (32%) patients treated with vigabatrin. All findings were reversible following discontinuation of therapy. Diffusion-weighted imaging (DWI) was positive with apparent diffusion coefficient (ADC) maps demonstrating restricted diffusion. Affected versus unaffected patients, respectively, had a median age of 11 months versus 5 years, therapy duration 3 months versus 12 months, and dosage 170 mg/kg/day versus 87 mg/kg/day. All affected patients were treated for infantile spasms; none of 56 patients with infantile spasms who were not treated with vigabatrin showed the same abnormalities.


CONCLUSIONS
MRI abnormalities attributable to vigabatrin, characterized by new-onset and reversible T(2)-weighted hyperintensities and restricted diffusion in thalami, globus pallidus, dentate nuclei, brainstem, or corpus callosum were identified in 8 of 23 patients. Young age and relatively high dose appear to be risk factors.
Pearl
Phillip L
PL
Department of Neurology, Children's National Medical Center, Washington DC, USA.
Vezina
Louis G
LG
Saneto
Russell P
RP
McCarter
Robert
R
Molloy-Wells
Elizabeth
E
Heffron
Ari
A
Trzcinski
Stacey
S
McClintock
William M
WM
Conry
Joan A
JA
Elling
Nancy J
NJ
Goodkin
Howard P
HP
de Menezes
Marcio Sotero
MS
Ferri
Raymond
R
Gilles
Elizabeth
E
Kadom
Nadja
N
Gaillard
William D
WD
D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects* / Q000473:pathology; D001929:Brain Edema / Q000139:chemically induced / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009186:Myelin Sheath / Q000187:drug effects / Q000473:pathology; D012075:Remission, Spontaneous; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000209:etiology; D020888:Vigabatrin / Q000009:adverse effects* / Q000627:therapeutic use
D000927:Anticonvulsants; D020888:Vigabatrin