Treatment with Topiramate and Vigabatrin in Infantile Spasms

초록

Treatment with topiramate and vigabatrin in infantile spasms Y.S. Kwon, D.H. Kim, S.K. Kim, B.K.Son Department of Pediatrics, College of Medicine, Inha University, Incheon, Korea Rationale: Infantile spasm is an age-related, catastrophic childhood epilepsy syndrome. The aim of this study was to evaluate the efficacy and tolerability of combined treatment with topiramate and vigabatrin for 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: 17 children were included in this review. Age of onset of spasms ranged from 3 to 12months with idiopathic (4 subjects) and symptomatic (13 subjects) etiologies. Nine of 17 patients (53%) became spasm free and disappearance of hypsarrhythmia as seen via EEG. Responders included seven patients with symptomatic and two patients with idiopathic infantile spasms. Six of 17 patients (35%) achieved a seizure reduction of more than 50%. The spasm frequency decreased from 11.4 ± 8.8 to 2.3 ± 1.9 spasm/day. Mild adverse effects during treatment included rash, lethargy, irritability, oligohidrosis. Conclusion: Our results suggest that a combination of treatment with topiramate and vigabatrin should be considered as an option for treating infantile spasms.