Reactions Weekly | 2021
Vigabatrin
Abstract
Reversible MRI abnormalities in an infant: case report A 10-month-old boy developed vigabatrin associated brain abnormalities on MRI during the treatment with vigabatrin for tuberous sclerosis complex (TSC). The boy was noted to have cardiac rhabdomyomas during prenatal ultrasound at 34 week of gestation. After delivery, on postnatal ultrasound examination, a cyst was noted in the right kidney. Brain MRI scan revealed several scattered cortical tubers and multi subependymal nodules. TSC was diagnosed. At the age of 4 months, he exhibited several episodes of head tilting to the right, right arm extension and short arrest of motor activity which was lasting for 1 minute. Complex partial seizures was considered. He was enrolled in a double blind and randomised seizure prevention clinical trial for infants with TSC because of refractory nature of these complex partial seizures to conventional antiepileptic treatment. Thereafter, he started receiving treatment with vigabatrin 150 mg/kg/day [route not stated]. At the age of 10 month, an EEG reported seizures with breakthrough events. Later, he was admitted to hospital for continuous video EEG to reveal seizure frequency. MRI scan prior to discharge showed a systematic pattern of diffusion restriction containing subthalamic nuclei, bilateral thalami, central tegmental tracts and dentate nuclei. Vigabatrin related brain abnormalities on MRI was suspected. Upon clinician advice, vigabatrin dose was reduced to 100 mg/kg/day. During 9 months follow-up, he reported no seizures and brain MRI scan revealed resolution of previously seen lesions.