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July 16, 2020
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Teaching NeuroImages: Reversible neuroimaging findings during treatment of infantile spasms with vigabatrin

October 20, 2020 issue
95 (16) e2314-e2315
A 10-month-old boy with global developmental delay presented to clinic with a few months of infantile spasms occurring multiple times a day. His seizures continued despite vigabatrin (dosed at 133 mg/kg/d), levetiracetam, and steroid therapy. On vigabatrin, routine follow-up MRI showed abnormal signal change (figure), which may occur in 30.9% of patients.1 Risk is associated with a high peak dose but not cumulative.2 These findings are largely asymptomatic although rarely patients can present with hyperkinetic disorders.2 The imaging findings resolved on 4-month follow-up after tapering vigabatrin. At 18 months of age, the patient continues to have 1 seizure every 2 weeks.
Figure Reversible abnormal MRI findings during treatment of infantile spasms with vigabatrin
Diffusion-weighted imaging showed symmetrical signal change in bilateral thalami (A, B), globus pallidi (B, C), cerebral peduncles (D), central tegmental tracts (D–F), and dentate nuclei (F). Apparent diffusion coefficient maps showed corresponding changes (not pictured). Follow-up imaging 4 months later showed resolution of the changes seen earlier (not pictured).

Appendix Authors

Footnote

Teaching slides links.lww.com/WNL/B176

References

1.
Dracopoulos A, Widjaja E, Raybaud C, Westall CA, Snead OC III. Vigabatrin-associated reversible MRI signal changes in patients with infantile spasms. Epilepsia 2010;51:1297–1304.
2.
Hussain SA, Tsao J, Li M, et al. Risk of vigabatrin-associated brain abnormalities on MRI in the treatment of infantile spasms is dose-dependent. Epilepsia 2017;58:674–682.

Information & Authors

Information

Published In

Neurology®
Volume 95Number 16October 20, 2020
Pages: e2314-e2315
PubMed: 32675075

Publication History

Published online: July 16, 2020
Published in print: October 20, 2020

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

From the Department of Clinical Neurological Sciences (D.D.K., A.K.S.), Division of Neuroradiology, Department of Radiology (M.S.), and Division of Pediatric Neurology, Department of Pediatrics (A.A.), Western University, London, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
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1.
NONE
License Fee Payments, Technology or Inventions:
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NONE
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NONE
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NONE
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From the Department of Clinical Neurological Sciences (D.D.K., A.K.S.), Division of Neuroradiology, Department of Radiology (M.S.), and Division of Pediatric Neurology, Department of Pediatrics (A.A.), Western University, London, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
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NONE
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1.
NONE
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Manas Sharma, MD
From the Department of Clinical Neurological Sciences (D.D.K., A.K.S.), Division of Neuroradiology, Department of Radiology (M.S.), and Division of Pediatric Neurology, Department of Pediatrics (A.A.), Western University, London, Canada.
Disclosure
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1.
NONE
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1.
NONE
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1.
NONE
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(1) Canadian Journal of Neuro Sciences, Associate Editor (Neuroradiology), no compensation
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NONE
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1.
NONE
Employment, Commercial Entity:
1.
NONE
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1.
NONE
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1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
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1.
NONE
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Andrea Andrade, MD
From the Department of Clinical Neurological Sciences (D.D.K., A.K.S.), Division of Neuroradiology, Department of Radiology (M.S.), and Division of Pediatric Neurology, Department of Pediatrics (A.A.), Western University, London, Canada.
Disclosure
Scientific Advisory Boards:
1.
UCB Canada ltd
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Esai Canada - Speaker honorarium
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
AMOSO innovation grant for a study in "Neuroimaging in drug resistant epilepsy" 67,000 CAD/year IRH grant 9000 CAD one year - Comprehensive epilepsy approach impacts education of families of children wit drug resistant epilepsy
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1.
NONE
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NONE
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Notes

Correspondence Dr. Kim [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

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Cited By
  1. Magnetic Resonance Imaging-Based Distribution and Reversibility of Lesions in Pediatric Vigabatrin-Related Brain Toxicity, Pediatric Neurology, 148, (86-93), (2023).https://doi.org/10.1016/j.pediatrneurol.2023.08.012
    Crossref
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