Vigabatrin: new indication. An advance in infantile spasms.

In children with infantile spasms, vigabatrin monotherapy has been assessed in three published comparative trials. The small numbers of patients make it impossible to draw precise conclusions on effectiveness. However, a few days' treatment with a dose of about 100 mg/kg/day clears infantile spasms in a larger proportion of cases than a placebo or steroids. Vigabatrin seems to be more effective in Bourneville disease. The effect is sometimes transient: despite continued treatment, spasms or other types of epilepsy occur in approximately 50% of patients who are initially improved. In a trial versus ACTH, the lesser initial efficacy of vigabatrin was partly offset by a lower incidence of relapse and other types of seizures. Vigabatrin is effective in some children who are resistant to ACTH or steroids. As with steroids and ACTH, there is no proof that vigabatrin improves the long-term psychomotor development of these children. In comparative trials the incidence of adverse events was statistically lower on vigabatrin than on steroids. Most of the events were relatively mild neuropsychological effects, but a question mark still hangs over the possible neurotoxicity or oculotoxicity of vigabatrin during long-term administration.