[Reversible alterations in the neuroimages associated with vigabatrine treatment in infants with epileptic spasms].
BACKGROUND
Vigabatrin (VGB) is a first-line drug for the treatment of infantile spasms. Recently, several reports claim the existence of abnormalities in magnetic resonance imaging (MRI) (particularly affecting basal ganglia, and visible in T2 and diffusion sequences) in infants with spasms that were receiving high doses of VGB (> 100 mg/kg/day), which appear to be reversible after withdrawal of treatment.


METHODS
We present two cases with an epileptic encephalopathy in the first year of life and seizures consisting of infantile spasms. Both were treated with several antiepileptic drugs, including VGB up to a maximum dosage of 200 mg/kg/day. At the age of 11 and 28 months, respectively, MRI images showed marked signal hyperintensities on T2-sequences on bilateral globus pallidus, thalamus, posterior portion of the brainstem and dentate nuclei, also visible on diffusion sequences. Both had previous unaltered MRI studies. After excluding an underlying metabolic disease, VGB withdrawal is decided, appreciating the reversibility of those lesions in a prospective MRI study, three months later.


CONCLUSIONS
We must consider and carefully evaluate findings on brain MRI in infants receiving VGB at high doses for treatment of spasms. The apparent cytotoxic effect on basal ganglia could simulate metabolic/mitochondrial diseases. By knowing this effect of VGB and its typical MRI features, unnecessary testing can be avoided in young infants with epileptic encephalopathies, including complex procedures like muscle biopsy or a new metabolic screening.
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
M A
MA
Fernandez-Garcia
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
J J
JJ
Garcia-Penas
Hospital San Pedro de Alcantara, 10003 Caceres, Espana.
H
H
Gomez-Martin
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
I
I
Perez-Sebastian
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
E
E
Garcia-Esparza
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
S
S
Sirvent-Cerda
D000927:Anticonvulsants / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D004351:Drug Resistance; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D013036:Spasms, Infantile / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D020888:Vigabatrin / Q000627:therapeutic use*
D000927:Anticonvulsants; D020888:Vigabatrin