Vigabatrin-related adverse events for the treatment of epileptic spasms: systematic review and meta-analysis

Biswas, Asthik; Yossofzai, Omar; Vincent, Ajoy; Go, Cristina; Widjaja, Elysa

doi:10.1080/14737175.2020.1840356

Cited by 15 publications

(19 citation statements)

References 46 publications

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“…Previous studies have shown that the incidence of VABAM was 22%–32%, 2 and a recent report that included 53 studies indicated that the incidence of VABAM was 21% 16 . Among the 77 cases enrolled in the present study, 25 (32.5%) had VABAM, indicating a higher incidence than the previous reports in the literature (Table 2).…”

Section: Discussionmentioning

confidence: 98%

“…Meanwhile, in a recent study involving 10 children with VABAM, the peak dosage range was 24.2-113 mg/kg/ day. 2 Therefore, the correlation between peak dosage and the risk of VABAM is uncertain, and no clear standard is available for the specific risk dosage range. In our study we once again verified that the peak dosage of VGB was the risk factor of VABAM, which was consistent with the research of Hussain et al 10 In addition, 23 of 25 VABAM cases had a peak dosage of VGB between 50 and150 mg/ kg/day, which suggested that VABAM might occur even using the conventional dosage of VGB (ie, 50-150 mg/ kg/day), so regular cerebral MRI examination should be required.…”

Section: Discussionmentioning

confidence: 99%

“…However, the report included a case of a child with a peak dosage of 26.5 mg/kg/day. Meanwhile, in a recent study involving 10 children with VABAM, the peak dosage range was 24.2–113 mg/kg/day 2 …”

Section: Discussionmentioning

confidence: 99%

“…Approved in the United States since 2009 for the treatment of infantile spasms (IS, an infantile epileptic encephalopathy), vigabatrin (VGB) and hormone therapy have been proven to be effective in reducing or eliminating spasms and hypsarrhythmia, thereby improving the long‐term prognosis of children with IS 1–3 4 .…”

Section: Introductionmentioning

confidence: 99%

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Risk of vigabatrin‐associated brain abnormalities on MRI: A retrospective and controlled study

Wan

et al. 2021

Epilepsia

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Objective: Vigabatrin (VGB) is the first-line treatment for infantile spasms (IS).Previous studies have shown that VGB exposure may cause vigabatrin-associated brain abnormalities on magnetic resonance imaging (MRI) (VABAM). Based on previous studies, this study aimed to go further to explore the possible risk factors and the incidence of VABAM. In addition, diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) were compared to explore whether DWI should be used as a routine examination sequence when MRI is performed in children receiving VGB. Methods:Children with IS receiving VGB were selected as the study subjects.Whether VABAM occurred or not was categorized as the VABAM group and the non-VABAM group, respectively. Their general clinical data and medication exposure were collected. The possible risk factors of VABAM and different MRI sequences were compared and statistically analyzed.Results: A total of 77 children with IS were enrolled in the study, of which 25 (32.5%) developed VABAM. Twenty-three of the 25 VABAM cases have a peak dosage of VGB between 50 and 150 mg/kg/day. The earliest observation time of VABAM was 30 days. Regression analysis of relevant risk factors showed that the peak dosage of VGB was the risk factor for VABAM. Comparison between different MRI sequences showed that DWI is more sensitive than T2WI to the evaluation of VABAM.Significance: In our study, the occurrence of VABAM was 32.5%, indicating a higher incidence than in most previous reports. In addition, we once again verified that the peak dosage of VGB was the risk factor of VABAM. Caution should be exercised that our data also suggest that VABAM may occur even using the conventional dosage of VGB (ie, 50-150 mg/kg/day). Therefore, even when using the conventional dosage of VGB, regular MRI examination should be required.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of vigabatrin‐associated brain abnormalities on MRI: A retrospective and controlled study

Wan

et al. 2021

Epilepsia

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“…Children with Down syndrome may be more susceptible to vigabatrin changes. A recent meta‐analysis identified reversible changes in 88% of 57 infants with multiple aetiologies identified from 12 articles 25 . Twelve of these patients had clinical symptoms (encephalopathy and movement disorder) temporally associated with vigabatrin‐related MRI signal changes which resolved after cessation of vigabatrin.…”

Section: Discussionmentioning

confidence: 99%

Response to treatment and outcomes of infantile spasms in Down syndrome

Harvey

Allen

King

et al. 2022

Develop Med Child Neuro

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Aim To estimate the prevalence, and evaluate presentation, treatment response, treatment side effects, and long‐term seizure outcomes in all known cases of children with Down syndrome and infantile spasms on the island of Ireland. Method This was a 10‐year retrospective multicentre review of clinical records and investigations, focusing on treatment response, side effects, and long‐term outcomes. Results The prevalence of infantile spasms in Down syndrome was 3.0% during the study period. Fifty‐four infants were identified with median age of spasm onset at 201 days (interquartile range [IQR] 156–242). Spasm cessation was achieved in 88% (n=46) at a median of 110 days (IQR 5–66). The most common first‐line medications were prednisolone (n=20, 37%), vigabatrin (n=18, 33.3%), and sodium valproate (n=9, 16.7%). At follow‐up (median age 23.7mo; IQR 13.4–40.6), 25% had ongoing seizures and 85% had developmental concerns. Treatment within 60 days did not correlate with spasm cessation. Seventeen children (31%) experienced medication side effects, with vigabatrin accounting for 52%. Interpretation Prednisolone is an effective and well‐tolerated medication for treating infantile spasms in Down syndrome. Despite the high percentage of spasm cessation, developmental concerns and ongoing seizures were common.

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