A Clinical Study on Infantile Spasms with Vigabatrin Therapy

PURPOSE: Infantile spasms are considered an age-specific and malignant epilepsy. It is not controlled easily by general anticonvulsants. Therefore, this study aimed to assess vigabatrin(VGT) efficacy in infantile spasms. METHODS: From January 1992 to December 1995, 35 children with infantile spasms, who were diagnosed at Kyung Hee University Hospital and treated vigabatrin, were analyzed retrospectively. RESULTS: The ratio of male to female was 1.7 : 1.2. Mean age at onset of infantile spasms was 7.6+/-3.4 months old and mean duration from onset of the disease to the beginning of the treatment was 2.4 months. Mean duration of vigabatrin treatment was 24.2 months. The most common type of infantile spasms was the flexion type with 26 cases(74.3%). Cryptogenic group had 13 cases and symptomatic group 22 cases. The most common causes were tuberous sclerosis, agyria-pachygyria, brain atrophy and hygroma(each are 4 cases). Among vigabatrin monotherapy(15 cases), complete cessation of seizure were 2 cases and 99-75% seizure reduction was 6 cases and among vigabatrin add-on therapy(20 cases), complete cessation was 4 cases and 99-75% seizure reduction was 6 cases. The most common combined anticonvulsant used was prednisolone. CONCLUSION: The effectiveness of vigabatrin in infantile spasms was good due to more than 75% reduction in seizure frequency in 51.4% of cases. Vigabatrin should be used in refractory infantile spasms.

Role of Serum Ca and 1,25(OH)2D3 as Predictor in Bone Metabolism Abnormality by Chronic Medication of Anticonvulsant

PURPOSE: Chronic use of anticonvulsant bring about abnormalities of bone metabolism, as hypocalcemia, rickets and osteomalacia. Early detection and treatment of abnormalities is important to pediatric patients. To investigate the usefulness of the serum Ca and 1,25(OH)2D3 as an predictor of bone metabolism abnormality, the study was done. METHODS: Serum Ca, P, ALP and 1,25(OH)2D3 were measured and analyzed in 48 children who diagnosed as convulsive disorder and took anticonvulsant medication over 6 months in Pediatric Department of Kyung Hee Medical Center. RESULTS: 1) Average duration of medication was 3.4+/-2.5yrs. 2) Values of serum Ca and P, ALP, 1,25(OH)2D3 were normal. 3) Serum levels of anticonvulsants were therapeutic range. 4) 1,25(OH)2D3 had significant correlation to serum Ca (P<0.005) and P (P<0.05) but no correlation to ALP. 5) Duration of medication had significant correlation to 1,25(OH)2D3 (P<0.05) but no correlation to Ca. 6) Duration of medication had no correlation to 1,25(OH)2D3 and Ca. CONCLUSIONS: Because 1,25(OH)2D3 is a good predictor for change of bone metabolism by chronic medication of anticonvulsant than Ca, its regular check is necessary.