Document Detail


Treatment of infantile spasms: results of a population-based study with vigabatrin as the first drug for spasms.
MedLine Citation:
PMID:  10403219     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The efficacy of a protocol consisting of vigabatrin (VGB) as the first and adrenocorticotropic hormone (ACTH) or valproate (VPA) as the second drug was studied in the treatment of newly diagnosed infantile spasms (IS) during 1994 to 1997 in a population-based design. METHODS: Only total disappearance of the spasms with a minimal duration of 1 month was accepted as a response. The treatment response was confirmed by video-EEG study. All infants were studied by magnetic resonance imaging (MRI) or computed tomography (CT) for etiology. RESULTS: Altogether 42 infants, 10 with cryptogenic and 32 with symptomatic etiology, were treated. Eleven (26%) responded to VGB, five (50%) with cryptogenic, and six (19%) with symptomatic etiology; 91% of infants responded to a dose of 50-100 mg/kg/day, and 82% of them within 1 week. ACTH was offered in combination with VGB to 22 and VPA to four infants for whom VGB failed. Eleven responded to ACTH and one to VPA. In total, 26 (62%) infants responded to the treatment protocol; all (100%) with cryptogenic etiology and 16 (50%) with symptomatic etiology. ACTH treatment was associated with more severe side effects than VGB or VPA. Only one infant relapsed after a spasm-free period with VGB of >4 months, but none after ACTH was combined with VGB. CONCLUSIONS: We suggest VGB as a first drug to all infants with IS. After a treatment trial of 10-14 days with increasing dose from 50 to 150 mg/kg, ACTH should be considered.
Authors:
M L Granström; E Gaily; E Liukkonen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Epilepsia     Volume:  40     ISSN:  0013-9580     ISO Abbreviation:  Epilepsia     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-07-19     Completed Date:  1999-07-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  950-7     Citation Subset:  IM    
Affiliation:
Epilepsy Unit, Hospital for Children and Adolescents, University of Helsinki, Finland.
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MeSH Terms
Descriptor/Qualifier:
4-Aminobutyrate Transaminase / antagonists & inhibitors
Adrenocorticotropic Hormone / therapeutic use
Anticonvulsants / therapeutic use*
Brain Diseases / diagnosis
Child
Clinical Protocols
Drug Administration Schedule
Drug Therapy, Combination
Electroencephalography / statistics & numerical data
Finland / epidemiology
Humans
Incidence
Magnetic Resonance Imaging
Spasms, Infantile / diagnosis,  drug therapy*,  epidemiology
Tomography, X-Ray Computed
Treatment Outcome
Valproic Acid / therapeutic use
Videotape Recording
Vigabatrin
gamma-Aminobutyric Acid / analogs & derivatives*,  therapeutic use
Chemical
Reg. No./Substance:
0/Anticonvulsants; 56-12-2/gamma-Aminobutyric Acid; 60643-86-9/Vigabatrin; 9002-60-2/Adrenocorticotropic Hormone; 99-66-1/Valproic Acid; EC 2.6.1.19/4-Aminobutyrate Transaminase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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