Magnetic resonance imaging abnormalities associated with vigabatrin in patients with epilepsy.
OBJECTIVE
Vigabatrin used to treat infantile spasms (IS) has been associated with transient magnetic resonance imaging (MRI) abnormalities. We carried out a retrospective review to better characterize the frequency of those abnormalities in IS and in children and adults treated with vigabatrin for refractory complex partial seizures (CPS).


METHODS
Medical records and 332 cranial MRIs from 205 infants (aged <or=24 months) with IS treated at 10 sites in the United States and Canada were collected. Similarly, 2,074 images from 668 children (aged 2-16 years) and adults (aged >16 years) with CPS were re-reviewed. Prespecified MRI abnormalities were defined as any hyperintensity on T(2)-weighted or fluid-attenuated inversion-recovery (FLAIR) sequences with or without diffusion restriction not readily explained by a radiographically well-characterized pathology. MRIs were read by two neuroradiologists blinded to treatment group. The incidence and prevalence of MRI abnormalities associated with vigabatrin were estimated.


RESULTS
Among infants with IS, the prevalence of prespecified MRI abnormalities was significantly higher among vigabatrin-treated versus vigabatrin-naive subjects (22% vs. 4%; p < 0.001). Of nine subjects in the prevalence population with at least one subsequent determinate MRI, resolution of MRI abnormalities occurred in six (66.7%)-vigabatrin was discontinued in four. Among adults and children treated with vigabatrin for CPS, there was no statistically significant difference in the incidence or prevalence of prespecified MRI abnormalities between vigabatrin-exposed and vigabatrin-naive subjects.


CONCLUSIONS
Vigabatrin is associated with transient, asymptomatic MRI abnormalities in infants treated for IS. The majority of these MRI abnormalities resolved, even in subjects who remained on vigabatrin therapy.
Wheless
James W
JW
LeBonheur Neuroscience Institute, University of Tennessee Health Science Center, Memphis, Tennessee 38105, USA. jwheless@utmem.edu
Carmant
Lionel
L
Bebin
Martina
M
Conry
Joan A
JA
Chiron
Catherine
C
Elterman
Roy D
RD
Frost
Michael
M
Paolicchi
Juliann M
JM
Donald Shields
W
W
Thiele
Elizabeth A
EA
Zupanc
Mary L
ML
Collins
Stephen D
SD
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use / Q000633:toxicity*; D001921:Brain / Q000187:drug effects* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D038524:Diffusion Magnetic Resonance Imaging; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D017029:Epilepsy, Complex Partial / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015994:Incidence; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000209:etiology; D020888:Vigabatrin / Q000627:therapeutic use / Q000633:toxicity*; D055815:Young Adult
D000927:Anticonvulsants; D020888:Vigabatrin