Reversible abnormalities in brain magnetic resonance imaging of children with infantile spasms during treatments with Vigabatrin / 中华实用儿科临床杂志

ABSTRACT

Objective:To summarize the abnormalities in brain magnetic resonance imaging (MRI) and clinical manifestations of children with infantile spasms (IS) in the course of Vigabatrin (VGB) treatment.Methods:The imaging features of children with IS who took VGB orally and presented with brain MRI changes in Peking University First Hospital between September 2016 and June 2018 were analyzed retrospectively.Their use of VGB and the imaging findings were followed up.Meanwhile, the imaging and clinical features of 83 cases described in literature were summarized.Results:(1) Ten children diagnosed as IS were included.The average duration of VGB treatment at the time of imaging changes was 4.1 months, the average age was 11.8 months, and the average maximum dose was 90.6 mg/(kg·d). Brain MRI showed hyperintensities in bilateral thalamus, brainstem, basal ganglia and dentate nucleus diffusion-weight imaging (DWI), with or without T2WI, and T2 fluid attenuated inversion recovery(FLAIR) or slight hyperintensities.Brain MRI repeated in 5 patients 7-12 months later revealed that the original abnormal signals completely disappeared.Among them, 4 patients stopped using VGB and 1 patient continued to take VGB.(2) Literature review 83 cases with IS treated with VGB from 16 literatures were reviewed, and the incidence of abnormal brain MRI was 22%-32%.The average age at initial VGB treatment was 8.0 months, and the average dose of VGB was 157.1 mg/(kg·d) when the brain MRI abnormalities were found.The MRI imaging showed high DWI signals in bilateral symmetrical thalamus, brainstem, basal ganglia (mainly pallidum) and dentate nucleus.During the follow-up of the 41 cases, no imaging abnormality was observed in 36 cases, improvement in 4 cases, and no significant change in 1 case.When MRI abnormalities were identified, 12.0%(10/83 cases) of the patients presented new clinical symptoms mainly in the extrapyramidal system, and the clinical symptoms of all children disappeared during the follow-up.Conclusions:During the course of VGB treatment of infantile spasms, brain MRI may suggest hyperintensities of DWI in the thalamus, brainstem, basal ganglia and dentate nucleus, but most are reversible.