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Article

Optimized Treatment for Infantile Spasms: Vigabatrin versus Prednisolone versus Combination Therapy

by
Jongsung Hahn
1,
Gyunam Park
1,
Hoon-Chul Kang
2,
Joon Soo Lee
2,
Heung Dong Kim
2,
Se Hee Kim
2,* and
Min Jung Chang
1,3,*
1
Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Korea
2
Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Patients’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
3
Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon 21983, Korea
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(10), 1591; https://doi.org/10.3390/jcm8101591
Submission received: 30 August 2019 / Revised: 27 September 2019 / Accepted: 29 September 2019 / Published: 2 October 2019
(This article belongs to the Section Clinical Neurology)
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Abstract

Hormone therapies and vigabatrin are first-line agents in infantile spasms, but more than one-third of patients fail to respond to these treatments. This was a retrospective study of patients with infantile spasms who were treated between January 2005 and December 2017. We analyzed the response rates of initial treatment and second-line treatment. Responders were defined as those in whom cessation of spasms was observed for a period of at least one month, within 2 weeks of treatment initiation. Regarding the response rate to initial treatment, combination therapy of vigabatrin with prednisolone showed a significantly better response than that of vigabatrin monotherapy (55.3% vs. 39.1%, p = 0.037). Many drugs, such as clobazam, topiramate, and levetiracetam, were used as second-line agents after the failure of vigabatrin. Among these, no antiepileptic drug showed as good a response as prednisolone. For patients who used prednisolone, the proportion of responders was significantly higher in the higher-dose group (≥40 mg/day) than in the lower-dose group (66.7% vs. 12.5%, p = 0.028). Further studies of combination therapy to assess dosage protocols and long-term outcomes are needed.
Keywords: Infantile spasms; First-line treatment; Combination of vigabatrin with prednisolone; Higher dose of prednisolone Infantile spasms; First-line treatment; Combination of vigabatrin with prednisolone; Higher dose of prednisolone

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MDPI and ACS Style

Hahn, J.; Park, G.; Kang, H.-C.; Lee, J.S.; Kim, H.D.; Kim, S.H.; Chang, M.J. Optimized Treatment for Infantile Spasms: Vigabatrin versus Prednisolone versus Combination Therapy. J. Clin. Med. 2019, 8, 1591. https://doi.org/10.3390/jcm8101591

AMA Style

Hahn J, Park G, Kang H-C, Lee JS, Kim HD, Kim SH, Chang MJ. Optimized Treatment for Infantile Spasms: Vigabatrin versus Prednisolone versus Combination Therapy. Journal of Clinical Medicine. 2019; 8(10):1591. https://doi.org/10.3390/jcm8101591

Chicago/Turabian Style

Hahn, Jongsung, Gyunam Park, Hoon-Chul Kang, Joon Soo Lee, Heung Dong Kim, Se Hee Kim, and Min Jung Chang. 2019. "Optimized Treatment for Infantile Spasms: Vigabatrin versus Prednisolone versus Combination Therapy" Journal of Clinical Medicine 8, no. 10: 1591. https://doi.org/10.3390/jcm8101591

APA Style

Hahn, J., Park, G., Kang, H.-C., Lee, J. S., Kim, H. D., Kim, S. H., & Chang, M. J. (2019). Optimized Treatment for Infantile Spasms: Vigabatrin versus Prednisolone versus Combination Therapy. Journal of Clinical Medicine, 8(10), 1591. https://doi.org/10.3390/jcm8101591

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