Impact of vigabatrin on risk of relapse of infantile spasms.
Moderate-dose vigabatrin linked to lower relapse risk after infantile spasms respond.
Impact of vigabatrin on risk of relapse of infantile spasms.
Vigabatrin is an effective treatment for infantile epileptic spasms syndrome (infantile epileptic spasms syndrome), but relapse remains a clinical challenge.
We set out to identify treatment-related predictors of infantile epileptic spasms syndrome relapse after initial vigabatrin response.
We conducted a retrospective cohort study of infants with infantile epileptic spasms syndrome who achieved electroclinical response within 30 days of vigabatrin initiation (alone or with hormonal therapy) and remained in remission for ≥ 30 days.
moderate dosing cut relapse risk versus lower doses
Of 164 responders, 63 (38%) relapsed at a median of 7.5 months (IQR: 2.4-18.0) after response.
Twenty-one (33.3%) relapses occurred following vigabatrin discontinuation.
In propensity score-adjusted multivariable regression, increased relapse risk was associated with prior infantile epileptic spasms syndrome relapse (HR 2.35; 95% CI 1.24-4.45; P = 0.009), other seizure types at infantile epileptic spasms syndrome onset (HR 2.31; 95% CI 1.31-4.07; P = 0.004), and abnormal development at infantile epileptic spasms syndrome diagnosis (HR 1.75; 95% CI 1.04-2.95; P = 0.035).
Infantile Epileptic Spasms Syndrome is a serious seizure disorder of infancy that can recur even after successful treatment with vigabatrin.
In this study of 164 infants, we found that relapse was most common among children with prior relapses, other seizure types, or developmental delays.
Infants treated with moderate vigabatrin doses (100-149 mg/kg/day) had the lowest relapse rates. These findings may help clinicians identify which infants face the highest risk and tailor treatment accordingly.