Clinical profile and treatment of infantile spasms using vigabatrin and ACTH - a developing country perspective

BMC Pediatrics

Research Article

Shahnaz Ibrahim¹  Shamshad Gulab¹  Sidra Ishaque²  Taimur Saleem³ 

[1] Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan;Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan;Medical College, The Aga Khan University, Stadium Road, 74800, Karachi, Pakistan;Medical College, The Aga Khan University, Stadium Road, 74800, Karachi, Pakistan;

关键词: Tuberous Sclerosis;    Vigabatrin;    Zonisamide;    Line Therapy;    Infantile Spasm;   

DOI  :  10.1186/1471-2431-10-1

 received in 2009-06-27, accepted in 2010-01-15,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundInfantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of patients with infantile spasms from Pakistan.MethodsAll patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned above. The type of drug distribution was random according to the availability, cost and ease of administration.ResultsFifty six cases fulfilled the inclusion criteria. 62.5% were males. Mean age at onset of seizures was 5 ± 1.4 months. Fifty two (92.8%) patients demonstrated hypsarrythmia on electroencephalography. 64.3% cases were identified as symptomatic while 19.6% were cryptogenic and 16.1% were idiopathic. Eighteen patients received ACTH while 38 patients received Vigabatrin as first line therapy. Initial response to first line therapy was similar (50% for ACTH and 55.3% for Vigabatrin). Overall, the symptomatic and idiopathic groups responded better to Vigabatrin. The relapse rate was higher for ACTH as compared to Vigabatrin (55.5% vs. 33.3%) when considering the first line therapy. Four patients evolved to Lennox-Gastaut variant; all of these patients had initially received Vigabatrin and then ACTH.ConclusionVigabatrin and ACTH showed no significant difference in the initial treatment of infantile spasms. However, patients receiving ACTH were 1.2 times more likely to relapse as compared to the patients receiving Vigabatrin when considering monotherapy. We suggest that Vigabatrin should be the initial drug of choice in patients presenting with infantile spasms. However, larger studies from developing countries are required to validate the therapeutic trends observed in this study.

【 授权许可】

Unknown   
© Ibrahim et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.