[P3-43] Outcome of Treatment Protocol for Infantile Spasms using Vigabatrin and High-Dose Prednisolone
[Object]
Optimal treatment for infantile spasms continues to be debated. This study assesses a treatment protocol using vigabatrin (VGB) and high-dose prednisolone (PL), for its efficacy in clinical remission and electrographic resolution of hypsarrhythmia.
[Methods]
Treatment protocol for West syndrome was drawn up as follows: 50 mg/kg of VGB for 1 day, followed by 100 mg/kg of VGB. If indicated, VGB is dosed up to 150mg/kg on the 5th day. After 14 days of administration of VGB, add-on therapy of 40 mg of PL is conducted if indicated. Dosing-up to 60 mg of PL is done after 7 days if indicated. High-dose PL is used for 14 days, and later it is tapered off gradually in the next 14 days. The indications of dosing-up or adding-on of VGB or PL are persistence of clinical spasms and/or hypsarrhythmia on EEG. If patients had been taking VGB already, they jumped to the high-dose PL therapy.
[Results]
As a prospective study, 27 patients were enrolled since June 2016 in epilepsy clinic of Severance Children’s Hospital. 13 (48.1%) patients had underlying structural anomaly shown in brain MRI. 4 (14.8%) patients had pathologic genetic mutations identified. 13 (48.1%) were receiving other antiepileptic drugs (AEDs) at the time of protocol initiation. After following the protocol, 23 (85.2%) showed clinical remission and 16 (59.3%) showed EEG resolution on the 14th day. On the 28th day, 26 (96.3%) showed clinical remission and 24 (88.9%) showed EEG resolution.
[Conclusion]
Protocol using VGB and high-dose PL in infantile spasms seems to be effective.
Optimal treatment for infantile spasms continues to be debated. This study assesses a treatment protocol using vigabatrin (VGB) and high-dose prednisolone (PL), for its efficacy in clinical remission and electrographic resolution of hypsarrhythmia.
[Methods]
Treatment protocol for West syndrome was drawn up as follows: 50 mg/kg of VGB for 1 day, followed by 100 mg/kg of VGB. If indicated, VGB is dosed up to 150mg/kg on the 5th day. After 14 days of administration of VGB, add-on therapy of 40 mg of PL is conducted if indicated. Dosing-up to 60 mg of PL is done after 7 days if indicated. High-dose PL is used for 14 days, and later it is tapered off gradually in the next 14 days. The indications of dosing-up or adding-on of VGB or PL are persistence of clinical spasms and/or hypsarrhythmia on EEG. If patients had been taking VGB already, they jumped to the high-dose PL therapy.
[Results]
As a prospective study, 27 patients were enrolled since June 2016 in epilepsy clinic of Severance Children’s Hospital. 13 (48.1%) patients had underlying structural anomaly shown in brain MRI. 4 (14.8%) patients had pathologic genetic mutations identified. 13 (48.1%) were receiving other antiepileptic drugs (AEDs) at the time of protocol initiation. After following the protocol, 23 (85.2%) showed clinical remission and 16 (59.3%) showed EEG resolution on the 14th day. On the 28th day, 26 (96.3%) showed clinical remission and 24 (88.9%) showed EEG resolution.
[Conclusion]
Protocol using VGB and high-dose PL in infantile spasms seems to be effective.