title: Magnetic resonance imaging abnormalities associated with vigabatrin in patients with epilepsy.
abstract: 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.
authors.affiliation: LeBonheur Neuroscience Institute, University of Tennessee Health Science Center, Memphis, Tennessee 38105, USA. jwheless@utmem.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Wheless
authors.forename: Lionel
authors.initials: L
authors.lastname: Carmant
authors.forename: Martina
authors.initials: M
authors.lastname: Bebin
authors.forename: Joan A
authors.initials: JA
authors.lastname: Conry
authors.forename: Catherine
authors.initials: C
authors.lastname: Chiron
authors.forename: Roy D
authors.initials: RD
authors.lastname: Elterman
authors.forename: Michael
authors.initials: M
authors.lastname: Frost
authors.forename: Juliann M
authors.initials: JM
authors.lastname: Paolicchi
authors.forename: W
authors.initials: W
authors.lastname: Donald Shields
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Thiele
authors.forename: Mary L
authors.initials: ML
authors.lastname: Zupanc
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Collins
mesh_terms: 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
chemical_list: D000927:Anticonvulsants; D020888:Vigabatrin