Combined treatment with topiramate and vigabatrin in idiopathic infantile spasms

초록

Combined treatment with topiramate and vigabatrin in idiopathic infantile spasms Y.S. Kwon, D.H. Kim, B.K.Son Department of Pediatrics, College of Medicine, Inha University, Incheon, Korea Purpose: Infantile spasm is an age-related refractory epilepsy. The aim of this study was to evaluate the efficacy and tolerability of combined treatment with topiramate and vigabatrin for idiopathic infantile spasms. Methods: We reviewed the medical records of treatment with topiramate and vigabatrin for all children with infantile spasms between 2001 and 2008 at our institution. Topiramate were treated with an initial dose of 1 mg/kg/day, with a progressive titration of 1 mg/kg a week until their spasms were controlled and a maximum dose of 10 mg/kg/day was achieved. When control of spasms was not obtained with topiramate treatment, vigabatrin was added a daily dose of 50 mg/kg/day for 2weeks, followed by increments of 50 mg/kg/day at 2 week intervals, up to a maximum of 150 mg/kg/day. The evaluation of the treatment efficacy was based on the spasm frequency data that was obtained by EEG and by the parental count of spasm. Results: 10 children (7 male and 3 female) were included in this review. Age of onset of spasms ranged from 3 to 12months (mean 5.8±2.5 months). Five of 10 patients (50%) became spasm free and disappearance of hypsarrhythmia as seen via EEG. Two of 10 patients (20%) achieved a seizure reduction of more than 50%. The spasm frequency decreased from 14.7 ± 8.9 to 5.7 ± 3.9 spasm/day. Mild adverse effects during treatment included lethargy, irritability, sleep disturbance. Conclusion: Our results suggest that a combination of treatment with topiramate and vigabatrin should be considered as an option for treating idiopathic infantile spasms.