Efficacy of Early Addition of Vigabatrin in Non-Responder to Hormonal Treatment in a Resource Limited Cohort of Infantile West Syndrome

Objectives - This study aimed to assess the efficacy of vigabatrin as early add on therapy inpatientswho did not respond tohigh dose oral Prednisolone (8mg/kg/day) & ACTH (150IU/m2/day). Methods - This was an observational study conducted at a tertiary-level-hospital from August-2014 to August-2015. Children aged 2-months to 23-months presenting with infantile spasms with hypsarrhythmia or its variants on EEG were enrolled. The study participants were started on high dose Prednisolone (8 mg/kg/day maximum 60mg/day). Patient who did not respond to hormonal treatment were immediately started on Vigabatrin (50-150mg/kg/day) and hormonal treatment was tapered off. The primary outcome measure was cessation of spasms and clearance of hypsarrhythmia on EEG after initiating Vigabatrin in a cohort of non responders to hormonal therapy. The study was approved by the ethical committee of the college. Results - Fifteen children were started on Vigabatrin after failure to achieve response from hormonal therapy. The response was nearly 11/15 (73.33 %) which was significantly higher as compared to studies done earlier. Conclusion - Vigabatrin is good alternative when added sequentially in patients who failed hormonal therapy. Vigabatrin as add on drug resulted in better seizure control than ACTH and steroid alone.