Optimized Treatment for Infantile Spasms: Vigabatrin versus Prednisolone versus Combination Therapy

• Main Authors: Jongsung Hahn, Gyunam Park, Hoon-Chul Kang, Joon Soo Lee, Heung Dong Kim, Se Hee Kim, Min Jung Chang
• Format: Article
• Language: English
• Published: MDPI AG 2019-10-01
• Series: Journal of Clinical Medicine
• Subjects: infantile spasms; first-line treatment; combination of vigabatrin with prednisolone; higher dose of prednisolone
• Online Access: https://www.mdpi.com/2077-0383/8/10/1591

Hormone therapies and vigabatrin are first-line agents in infantile spasms, but more than one-third of patients fail to respond to these treatments. This was a retrospective study of patients with infantile spasms who were treated between January 2005 and December 2017. We analyzed the response rates of initial treatment and second-line treatment. Responders were defined as those in whom cessation of spasms was observed for a period of at least one month, within 2 weeks of treatment initiation. Regarding the response rate to initial treatment, combination therapy of vigabatrin with prednisolone showed a significantly better response than that of vigabatrin monotherapy (55.3% vs. 39.1%, <i>p</i> = 0.037). Many drugs, such as clobazam, topiramate, and levetiracetam, were used as second-line agents after the failure of vigabatrin. Among these, no antiepileptic drug showed as good a response as prednisolone. For patients who used prednisolone, the proportion of responders was significantly higher in the higher-dose group (&#8805;40 mg/day) than in the lower-dose group (66.7% vs. 12.5%, <i>p</i> = 0.028). Further studies of combination therapy to assess dosage protocols and long-term outcomes are needed.