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Corrêa DG, Telles B, Freddi TDAL. The vigabatrin-associated brain abnormalities on MRI and their differential diagnosis. Clin Radiol 2024; 79:94-101. [PMID: 38092645 DOI: 10.1016/j.crad.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/12/2023] [Accepted: 11/14/2023] [Indexed: 01/02/2024]
Abstract
Vigabatrin is an anti-epileptic drug that inhibits the enzyme γ-aminobutyric acid (GABA)-transaminase. The anticonvulsant effect of vigabatrin involves increasing GABA levels and attenuating glutamate-glutamine cycling. Vigabatrin indications include infantile spasms and refractory focal seizures. Despite having a significant role in paediatric epileptology, vigabatrin has adverse effects, such as retinal toxicity, in up to 30% of patients after 1 year of use and brain abnormalities on magnetic resonance imaging (MRI). The percentage of patients with brain abnormalities on MRI varies between 22-32% of children using vigabatrin to treat infantile spasms. Risk factors for presenting these imaging abnormalities are cryptogenic infantile spasms, age <12 months old, high dosage, and possible concomitant hormonal therapy. Clinically, these abnormalities are usually asymptomatic. Histopathological analysis reveals white matter vacuolation and intramyelinic oedema. The typical findings of vigabatrin-associated brain abnormalities on MRI are bilateral and have a symmetrical hyperintense signal on T2-weighted imaging, with diffusion restriction, that often compromise the globi pallidi, thalami, subthalamic nuclei, cerebral peduncles, midbrain, dorsal brainstem, including the medial longitudinal fasciculi, and dentate nuclei of the cerebellum. In this article, the authors intend to review the clinical manifestations, histopathological features, imaging aspects, and differential diagnosis of vigabatrin-associated brain abnormalities on MRI.
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Affiliation(s)
- D G Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil; Department of Radiology, Rio de Janeiro State University, Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil.
| | - B Telles
- Department of Radiology, Curitiba Institute of Neurology, Rua Jeremias Maciel Perretto, 300, Campo Comprido, Curitiba, PR 81210-310, Brazil; Department of Radiology, Hospital Pequeno Príncipe, Rua Desembargador Motta, 1070, Água Verde, Curitiba, PR 80250-060, Brazil
| | - T de A L Freddi
- Department of Radiology, Hcor, Rua Desembargador Eliseu Guilherme, 147, Paraíso, São Paulo, SP 04004-030, Brazil
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Wan L, He W, Wang YY, Xu Y, Lu Q, Zhang MN, Wang QH, Dun S, Liu LY, Shi XY, Wang J, Hu LY, Zhang B, Yang G, Zou LP. Vigabatrin-associated brain abnormalities on MRI in tuberous sclerosis complex patients with infantile spasms: are they preventable? Ther Adv Neurol Disord 2022; 15:17562864221138148. [PMID: 36601084 PMCID: PMC9806385 DOI: 10.1177/17562864221138148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/22/2022] [Indexed: 12/28/2022] Open
Abstract
Background Vigabatrin (VGB) is currently the most widely prescribed first-line medication for individuals with infantile spasms (IS) and especially for those with tuberous sclerosis complex (TSC), with demonstrated efficacy. Meanwhile, its adverse events, such as vigabatrin-associated brain abnormalities on magnetic resonance imaging (MRI; VABAM), have also been widely reported. Objectives The objectives of this study were to observe the occurrences of VABAM in patients with IS caused by TSC (IST) and further explore the associated risk factors. Methods Children with IS receiving VGB were recruited from our institution; clinical, imaging, and medication data were collected. Cerebral MRI was reviewed to determine the occurrence of VABAM. Group comparisons (IS caused by TSC and other etiologies) were performed; subgroup analyses on IST were also performed. Next, a retrospective cohort study of children taking VGB was conducted to explore risk/protective factors associated with VABAM. Results The study enrolled 172 children with IS who received VGB. VABAM was observed in 38 patients (22.1%) with a peak dosage of 103.5 ± 26.7 mg/kg/day. Subsequent analysis found the incidence of VABAM was significantly lower in the 80 patients with IST than in the 92 patients with IS caused by other etiologies (10% versus 32.6%, p-value < 0.001). In subgroup analyses within the IST cohort, VABAM was significantly lower in children who received concomitant rapamycin therapy. Univariate and multivariate logistic regression analysis of the 172 IS children showed that treatment with rapamycin was the independent factor associated with a lower risk of VABAM; similar results were observed in the survival analysis. Conclusion The incidence of VABAM was significantly lower in IST patients. Further research is needed to examine the mechanisms that underlie this phenomenon and to determine if treatment with rapamycin may reduce the risk of VABAM.
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Affiliation(s)
| | | | | | - Yong Xu
- Department of Pediatrics, PLA General Hospital,
Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China
| | - Qian Lu
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China
| | - Meng-Na Zhang
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China
| | - Qiu-Hong Wang
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China
| | - Shuo Dun
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China
| | - Li-Ying Liu
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China
| | - Xiu-Yu Shi
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China,The Second School of Clinical Medicine,
Southern Medical University, Guangzhou, China
| | - Jing Wang
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China
| | - Lin-Yan Hu
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China
| | - Bo Zhang
- Department of Neurology and ICCTR
Biostatistics and Research Design Center, Boston Children’s Hospital,
Harvard Medical School, Boston, MA, USA
| | - Guang Yang
- Department of Pediatrics, PLA General
Hospital, Beijing, China,Division of Pediatrics, The First Medical
Center of PLA General Hospital, Beijing, China,Medical School of Chinese People’s Liberation
Army, Beijing, China,The Second School of Clinical Medicine,
Southern Medical University, Guangzhou, China
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Abstract
This article discusses new diffusion-weighted imaging (DWI) sequences, diffusion tensor imaging (DTI), and fiber tractography (FT), as well as more advanced diffusion imaging in pediatric brain and spine. Underlying disorder and pathophysiology causing diffusion abnormalities are discussed. Multishot echo planar imaging (EPI) DWI and non-EPI DWI provide higher spatial resolution with less susceptibility artifact and distortion, which are replacing conventional single-shot EPI DWI. DTI and FT have established clinical significance in pediatric brain and spine. This article discusses advanced diffusion imaging, including diffusion kurtosis imaging, neurite orientation dispersion and density imaging, diffusion spectrum imaging, intravoxel incoherent motion, and oscillating-gradient spin-echo.
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Affiliation(s)
- Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, UH B2 A209K, Ann Arbor, MI 48109, USA.
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Nabbout R, Kuchenbuch M, Chiron C, Curatolo P. Pharmacotherapy for Seizures in Tuberous Sclerosis Complex. CNS Drugs 2021; 35:965-983. [PMID: 34417984 DOI: 10.1007/s40263-021-00835-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 01/18/2023]
Abstract
Epilepsy is one of the main symptoms affecting the lives of individuals with tuberous sclerosis complex (TSC), causing a high rate of morbidity. Individuals with TSC can present with various types of seizures, epilepsies, and epilepsy syndromes that can coexist or appear in relation to age. Focal epilepsy is the most frequent epilepsy type with two developmental and epileptic encephalopathies: infantile spasms syndrome and Lennox-Gastaut syndrome. Active screening and early management of epilepsy is recommended in individuals with TSC to limit its consequences and its impact on quality of life, cognitive outcome and the economic burden of the disease. The progress in the knowledge of the mechanisms underlying epilepsy in TSC has paved the way for new concepts in the management of epilepsy related to TSC. In addition, we are moving from traditional "reactive" and therapeutic choices with current antiseizure medications used after the onset of seizures, to a proactive approach, aimed at predicting and preventing epileptogenesis and the onset of epilepsy with vigabatrin, and to personalized treatments with mechanistic therapies, namely mechanistic/mammalian target of rapamycin inhibitors. Indeed, epilepsy linked to TSC is one of the only epilepsies for which a predictive and preventive approach can delay seizure onset and improve seizure response. However, the efficacy of such interventions on long-term cognitive and psychiatric outcomes is still under investigation.
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Affiliation(s)
- Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, APHP, Université de Paris, 149 rue de Sèvres, 75015, Paris, France.
- UMR 1163, Institut National de la Santé et de la Recherche Médicale (INSERM), Imagine Institute, Université de Paris, Paris, France.
| | - Mathieu Kuchenbuch
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, APHP, Université de Paris, 149 rue de Sèvres, 75015, Paris, France
- UMR 1163, Institut National de la Santé et de la Recherche Médicale (INSERM), Imagine Institute, Université de Paris, Paris, France
| | - Catherine Chiron
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, APHP, Université de Paris, 149 rue de Sèvres, 75015, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1141, Neurospin, Gif sur Yvette, France
| | - Paolo Curatolo
- Department of System Medicine, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital, Rome, Italy
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Biswas A, Yossofzai O, Vincent A, Go C, Widjaja E. Vigabatrin-related adverse events for the treatment of epileptic spasms: systematic review and meta-analysis. Expert Rev Neurother 2020; 20:1315-1324. [PMID: 33078964 DOI: 10.1080/14737175.2020.1840356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Although vigabatrin (VGB) is effective and well tolerated for the treatment of epileptic spasms, there are safety concerns. The aim of this systematic review and metaanalysis was to assess adverse events of VGB for the treatment of epileptic spasms. Methods: MEDLINE, EMBASE, and Cochrane databases were searched. The population was infants treated with VGB for epileptic spasms. The outcomes were VGB-related adverse events. Meta-analyses of VGB-related MRI abnormalities, retinal toxicity as measured by electroretinogram (ERG), visual field defect as measured by perimetry, and other adverse events were conducted. Results: Fifty-seven articles were included in the systematic review. The rate of VGB-related MRI abnormalities was 21% (95% CI: 15-29%). Risk factors for MRI abnormalities were age younger than 12 months and higher VGB dose. VGB-related retinal toxicity and visual field defect occurred in 29% (95% CI: 7-69%) and 28% (95% CI: 4-78%) respectively. Other adverse events occurred in 23% (95% CI: 16-34%), consisting predominantly of central nervous system symptoms, and the majority of these did not require therapeutic modification. Conclusion: This study will inform physicians and families on the risk profile of VGB for the treatment of epileptic spasms and will help decisions on treatment options.
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Affiliation(s)
- Asthik Biswas
- Department of Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto , Toronto, ON, Canada
| | - Omar Yossofzai
- Neuroscience and Mental Health, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Ajoy Vincent
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto , Toronto, ON, Canada.,Neuroscience and Mental Health, The Hospital for Sick Children , Toronto, Ontario, Canada.,Division of Neurology, The Hospital for Sick Children , Toronto, Ontario, Canada
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Bhalla S, Skjei K. Fulminant vigabatrin toxicity during combination therapy with adrenocorticotropic hormone for infantile spasms: Three cases and review of the literature. Epilepsia 2020; 61:e159-e164. [PMID: 32944947 DOI: 10.1111/epi.16663] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/28/2022]
Abstract
Vigabatrin (VGB), adrenocorticotropic hormone (ACTH), and prednisone are first-line treatments for infantile spasms (IS). A recent study reported benefits from the use of combination VGB and hormonal therapy over hormonal treatment alone in IS. We describe three patients with IS who developed acute encephalopathy with extrapyramidal symptoms, vigabatrin-associated brain abnormalities on magnetic resonance imaging (VABAM), and death in one patient shortly after initiation of therapy with VGB and ACTH. A literature review supports increased risk of fulminant, symptomatic VABAM in patients receiving VGB in association with hormonal therapy, raising concerns regarding its safety in IS.
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Affiliation(s)
- Sonam Bhalla
- Department of Pediatrics, Division of Pediatric Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karen Skjei
- Department of Neurology, Division of Pediatric Neurology, University of Texas, Austin, Texas, USA
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Vigabatrin-Induced Encephalopathy in a 5.5-Month-Old Girl with Infantile Spasms due to Tuberous Sclerosis. Case Rep Pediatr 2019; 2019:7249237. [PMID: 31534811 PMCID: PMC6732644 DOI: 10.1155/2019/7249237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 12/29/2022] Open
Abstract
A 5.5-month-old female infant with tuberous sclerosis complex presented with infantile spasms and was treated with vigabatrin. As her condition did not improve, she was given adrenocorticotropic hormone (ACTH) intramuscularly which stopped the spasms and improved the electroencephalogram (EEG) abnormalities. However, she developed encephalopathy with apathy, drowsiness, and generalized slowing in the EEG. Discontinuation of vigabatrin quickly improved her symptoms and reversed the EEG slowing. A high index of suspicion is required in order to diagnose vigabatrin-induced encephalopathy, especially as the underlying disorders of these patients can be erroneously considered the cause of the observed encephalopathy.
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8
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Pearl PL, Poduri A, Prabhu SP, Harini C, Goldstein R, Atkinson RM, Armstrong D, Kinney H. White matter spongiosis with vigabatrin therapy for infantile spasms. Epilepsia 2018; 59:e40-e44. [PMID: 29473152 DOI: 10.1111/epi.14032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 11/26/2022]
Abstract
The histopathology, "white matter spongiosis," defined by electron microscopy (EM) as "intramyelinic edema," has been associated with vigabatrin therapy in various animal models, but its role or significance in clinical studies is unknown. We conducted a neuropathological examination on a 27-month-old boy with bilateral polymicrogyria and epilepsy after sudden unexpected death in epilepsy (SUDEP). The patient was initiated on vigabatrin at 4 months of age, which controlled infantile spasms, and was continued as maintenance therapy. Autopsy showed a combination of developmental and acquired lesions: (1) bilateral gyral malformations of the frontal, parietal, temporal, and insular cortex; (2) agenesis of the olfactory tracts and bulbs; (3) hippocampal abnormalities: dentate gyrus bilamination and granule cell dispersion; and (4) areas of microscopic bilateral, symmetric white matter spongiosis in the brainstem central tegmental tract, amiculum and hilum of the inferior olive, medial longitudinal fasciculus, paragigantocellularis lateralis, optic nerves and chiasm, and hypothalamus. The white matter spongiosis was identical to the histopathologic lesions (which by EM exhibited intramyelinic edema) that were demonstrated in animal models on vigabatrin therapy, indicating that vigabatrin toxicity is not restricted to animal models.
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Affiliation(s)
- Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Annapurna Poduri
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Robert's Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanjay P Prabhu
- Robert's Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chellamani Harini
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Goldstein
- Robert's Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Dawna Armstrong
- Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Hannah Kinney
- Robert's Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Annese V, Barcia C, Ros-Bernal F, Gómez A, Ros CM, De Pablos V, Fernández-Villalba E, De Stefano ME, Herrero MT. Evidence of oligodendrogliosis in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinsonism. Neuropathol Appl Neurobiol 2015; 39:132-43. [PMID: 22443457 DOI: 10.1111/j.1365-2990.2012.01271.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Mice and nonhuman primates administered with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) represent elective experimental models of Parkinsonism, in which degeneration of the nigrostriatal dopaminergic pathway is associated with prominent neuroinflammation, characterized by activated microglia and astrocytes in both substantia nigra (SN) and striatum. To date, it is unknown whether oligodendrocytes play a role in these events. METHODS We performed a detailed qualitative and quantitative analysis of oligodendrocyte-associated changes induced by acute and chronic MPTP treatment, in the SN and striatum of mice and macaques respectively. Oligodendrocytes were immunolabelled by cell-specific markers and analysed by confocal microscopy. RESULTS In both experimental models, MPTP treatment induces an increase in oligodendrocyte cell number and average size, as well as in the total area occupied by this cell type per tissue section, accompanied by evident morphological changes. This multifaceted array of changes, herein referred to as oligodendrogliosis, significantly correlates with the reduction in the level of dopaminergic innervation to the striatum. CONCLUSIONS This event, associated with early damage of the dopaminergic neurone axons and of the complex striatal circuits of which they are part, may result in an important, although neglected, aspect in the onset and progression of Parkinsonism.
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Affiliation(s)
- V Annese
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
| | - C Barcia
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
| | - F Ros-Bernal
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
| | - A Gómez
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
| | - C M Ros
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
| | - V De Pablos
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
| | - E Fernández-Villalba
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
| | - M E De Stefano
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
| | - M-T Herrero
- Clinical and Experimental NeuroscienceCentro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, Murcia, SpainIstituto Pasteur-Fondazione Cenci Bolognetti, Dip. di Biologia e Biotecnologie 'Charles Darwin'Center for Research in Neurobiology 'Daniel Bovet', Sapienza Università di Roma, P.le Aldo Moro, Roma, Italy
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Fosi T, Chu C, Chong WK, Clark C, Scott RC, Boyd S, De Haan M, Neville B. Quantitative magnetic resonance imaging evidence for altered structural remodeling of the temporal lobe in West syndrome. Epilepsia 2015; 56:608-16. [PMID: 25802930 PMCID: PMC5006860 DOI: 10.1111/epi.12907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2014] [Indexed: 12/05/2022]
Abstract
Objective To explore the structure–function relation of the temporal lobe in newly diagnosed West syndrome of unknown cause (uWS). Methods Quantitative magnetic resonance imaging (three‐dimensional [3D] structural MRI and diffusion tensor imaging [DTI]) was analyzed using voxel‐based morphometry (VBM) and tract‐based spatial statistics (TBSS) in 22 patients and healthy age‐matched controls. The electrophysiologic responsiveness of the temporal lobe was measured using the N100 auditory event‐related potential (aERP) to a repeated 1,000 Hz tone. Neurocognitive function was assessed using the Bayley Scales of Infant Development, Second Edition (BSID‐II). Tests followed first‐line treatment with vigabatrin (17 patients) or high‐dose oral prednisolone (5 patients). Results Total temporal lobe volume was similar in patients and controls. Patients had a smaller temporal stem (TS) (p < 0.0001) and planum temporale (PT) (p = 0.029) bilaterally. TS width asymmetry with a larger right‐sided width in controls was absent in patients (p = 0.033). PT asymmetry was present in both groups, being larger on the right (p = 0.048). VBM gray matter volume was increased at the left temporal lobe (superior and middle temporal gyri, the peri‐rhinal cortex, and medial temporal lobe) (p < 0.005, family wise error‐corrected). VBM gray matter volume correlated with the duration of infantile spasms (Pearson's r = −0.630, p = 0.009). DTI metrics did not differ between patients and controls on TBSS. Mean BSID‐II scores were lower (p < 0.001) and auditory N100 ERP attenuated less in patients than in controls (p = 0.002). Significance The functional networking and white matter development of the temporal lobe are impaired following infantile spasms. Treatment may promote structural plasticity within the temporal lobe following infantile spasms, manifest as increased gray matter volume on VBM. It remains to be investigated further whether this predicts patients' long‐term cognitive difficulties.
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Affiliation(s)
- Tangunu Fosi
- Young Epilepsy, Surrey, United Kingdom; Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Neurosciences Unit, University College London Institute of Child Health, London, United Kingdom
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Briggs SW, Mowrey W, Hall CB, Galanopoulou AS. CPP-115, a vigabatrin analogue, decreases spasms in the multiple-hit rat model of infantile spasms. Epilepsia 2013; 55:94-102. [PMID: 24321005 DOI: 10.1111/epi.12424] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Infantile spasms (IS) have poor outcomes and limited treatment options, including vigabatrin, a γ-aminobutyric acid (GABA) aminotransferase inactivator. Vigabatrin has been associated with retinal toxicity. A high affinity vigabatrin analogue (CPP-115; Catalyst Pharmaceutical Partners, Inc., Coral Gables, FL, U.S.A.) has shown lower risk of retinal toxicity. Here, we test the efficacy of CPP-115 in reducing spasms and its tolerability in the multiple-hit rat model of IS, in which daily vigabatrin reduced spasms for only one day, but was not well tolerated. METHODS Male rats were treated with the protocol of the multiple-hit model of IS on postnatal day 3 (PN3). Using a randomized, blinded, vehicle-controlled, dose-response study design, CPP-115 (0.1, 1, or 5 mg/kg intraperitoneally [i.p.]) or vehicle was given daily (PN4-12) or as a single injection (PN7) after spasm onset. Intermittent video- or video-electroencephalography (EEG) monitoring was done. Secondary end points included the following: daily weights, survival, performance on open field activity, surface righting time, and negative geotaxis (PN3-20), horizontal bar (PN13-20), and Barnes maze (PN16-19). Statistics used a linear mixed model of raw or normalized log-transformed data, taking into account the repeated observations on each animal. RESULTS The lower CPP-115 doses (0.1-1 mg/kg/day, PN4-12) reduced spasms between PN6 and 7 without increasing mortality. CPP-115 at 5 mg/kg/day (PN4-12) reduced spasms earlier (PN5), but was eventually lethal. A single CPP-115 injection (1 mg/kg, i.p.) decreased electroclinical spasms acutely but transiently. CPP-115 transiently improved the probability to >50% reduction of spasms, but did not accelerate spasm cessation. CPP-115 did not alter neurodevelopmental outcomes or visuospatial learning. SIGNIFICANCE We provide proof-of-concept evidence that CPP-115, a vigabatrin analogue, decreases spasms in the multiple-hit rat model of IS at considerably lower and better tolerated doses than vigabatrin did in our previous studies. Further optimization of the treatment protocol is needed. CPP-115 may be a promising new candidate treatment for IS with better tolerability than vigabatrin.
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Affiliation(s)
- Stephen W Briggs
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, U.S.A; Laboratory of Developmental Epilepsy and Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, U.S.A
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Dill P, Datta AN, Weber P, Schneider J. Are vigabatrin induced T2 hyperintensities in cranial MRI associated with acute encephalopathy and extrapyramidal symptoms? Eur J Paediatr Neurol 2013. [PMID: 23199677 DOI: 10.1016/j.ejpn.2012.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Reversible T2-hyperintensities in cranial MRI have been recently observed in infants with infantile spasms, who were treated with vigabatrin. In most cases, this phenomenon is solely been reported in neuroimaging practice without clinical relevance. We report two patients with infantile spasms, who not only developed transient T2-hyperintensities, but also presented acute encephalopathy, and extrapyramidal symptoms under vigabatrin therapy.
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Affiliation(s)
- Patricia Dill
- Division of Pediatric Neurology and Developmental Medicine, University Children's Hospital, University of Basel, Spitalstrasse 33, Basel, Switzerland.
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Abstract
Vigabatrin is an effective antiepileptic drug (AED) for the treatment of refractory complex partial seizures (rCPS) and infantile spasms (IS). In clinical trials, vigabatrin was generally well-tolerated with an adverse event profile similar to that of other AEDs. The most common treatment-related adverse events were central nervous system effects, including drowsiness, dizziness, headache, and fatigue, with adjunctive vigabatrin in adults with rCPS, and sedation, somnolence, and irritability with vigabatrin monotherapy in infants with IS. Vigabatrin had little effect on cognitive function, mood, or behavior in a battery of neuropsychologic tests for rCPS. In placebo-controlled clinical trials, the incidence of depression and psychosis, but not other psychiatric adverse events, was greater with vigabatrin than placebo. Intramyelinic edema (IME) was initially identified in rats and dogs and led to a temporary suspension of clinical trials in the United States. IME was subsequently correlated with delays in evoked potential (EP) and increased T(2) -weighted signals on magnetic resonance imaging (MRI). Clinical trials of vigabatrin were allowed to resume after IME was not detected by neuropathologic assessments of autopsy and neurosurgical specimens or by serial EP or MRI assessments in older children and adults receiving vigabatrin. Subsequently, MRI abnormalities characterized by increased T(2) intensity and restricted diffusion were identified in infants treated with vigabatrin for IS. These abnormalities generally resolved with discontinuation of vigabatrin and, in some cases, during continued therapy. The benefit of improved seizure control must be balanced against the potential risks associated with vigabatrin, including abnormal MRI changes and other vigabatrin-related safety issues.
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Affiliation(s)
- S D Walker
- Fleishman-Hillard Inc., Kansas City, MO 64108-2522, USA.
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15
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Abstract
Vigabatrin is an effective and well-tolerated antiepileptic drug (AED) for the treatment of refractory complex partial seizures (rCPS) and infantile spasms (IS), but its benefits must be evaluated in conjunction with its risk of retinopathy with the development of peripheral visual field defects (pVFDs). Vigabatrin should be considered for rCPS if a patient has failed appropriate trials of other AEDs or is not a suitable candidate for other AEDs, is not an optimal surgical candidate, and continues to experience debilitating effects from seizures. Vigabatrin is indicated as monotherapy for pediatric patients with IS. Its efficacy in achieving improved seizure control should be apparent within 12 weeks in patients with rCPS and within 2-4 weeks after attaining appropriate dosage for patients with IS. Because 12 weeks is well less than the known time of onset of visual defects, the risk of developing pVFDs may be minimized by discontinuing vigabatrin early during the course of therapy for patients with inadequate response. Appropriate vision screening is recommended at baseline, every 3 months during continued vigabatrin treatment, and at 3-6 months after discontinuation (if therapy has spanned more than a few months). If a pVFD is detected at any point and the decision is made to discontinue therapy, the pVFD is not likely to progress after discontinuation of vigabatrin. Although some patients will be at risk of retinopathy, vigabatrin is an appropriate treatment option for patients who achieve substantial clinical benefit, especially given the severe consequences of rCPS and uncontrolled IS. While retinopathy with the development of pVFDs is a serious adverse event, it is not life-threatening and its risk can be effectively managed.
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Affiliation(s)
- J M Pellock
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Kayani S, Sirsi D. The safety and tolerability of newer antiepileptic drugs in children and adolescents. J Cent Nerv Syst Dis 2012; 4:51-63. [PMID: 23650467 PMCID: PMC3619554 DOI: 10.4137/jcnsd.s5097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Childhood epilepsy continues to be intractable in more than 25% of patients diagnosed with epilepsy. The introduction of new anti-epileptic drugs (AEDs) provides more options for treatment of children with epilepsy. We review the safety and tolerability of seven new AEDs (levetiracetam, lamotrigine, oxcarbazepine, rufinamide, topiramate, vigabatrin and zonisamide) focusing on their side effect profiles and safety in children and adolescents. Many considerations that are specific for children such as the impact of AEDs on the developing brain are not addressed during the development of new AEDs. They are usually approved as adjunctive therapies based upon clinical trials involving adult patients with partial epilepsy. However, 2 of the AEDs reviewed here (rufinamide and vigabatrin) have FDA approval in the U.S. for specific Pediatric epilepsy syndromes, which are discussed below. The Pediatrician or Neurologists decision on the use of a new AED is an evolutionary process largely dependent on the patient characteristics, personal/peer experiences and literature about efficacy and safety profiles of these medications. Evidence based guidelines are limited due to a lack of randomized controlled trials involving pediatric patients for many of these new AEDs.
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Affiliation(s)
- Saima Kayani
- Department of Pediatric Neurology, University of Texas South Western Medical Center, Dallas, Texas
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T2 hyperintense signal of the central tegmental tracts in children: disease or normal maturational process? Neuroradiology 2012; 54:863-71. [PMID: 22271318 DOI: 10.1007/s00234-012-1006-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 01/05/2012] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cerebral central tegmental tract hyperintense signal on T2-weighted MRI (CTTH) is known from various clinical conditions, including children treated with vigabatrin (VGB) for West syndrome (WS), with hypoxic-ischemic brain injury, and metabolic diseases. Considering this clinical diversity, we hypothesized that CTTH might primarily mirror a physiologic process. METHODS We retrospectively analysed brain MRI data of the central tegmental tracts deriving from four different groups: (1) children with WS and VGB therapy (WS+VGB+), (2) children with WS but without VGB therapy (WS+VGB-), (3) children with different neurological diseases (WS-VGB-; maximum age 15 years), and (4) controls younger than 25 months of age (this age includes the peak age of WS). RESULTS CTTH were detected in 4/17 WS+VGB+ children (24%), 4/34 WS+VGB- children (12%), 18/296 WS-VGB- children (6%), and 8/112 controls (7%). Independently from the underlying diagnosis, CTTH showed a peak age during early infancy and were not found before 4 months and after 7 years of life. The rate of CTTH among WS children ± VGB therapy was similar so that VGB therapy seems of minor etiological impact. However, comparison of WS patients younger than 25 months of age (CTTH present in 7/40) with age-matched controls (CTTH present in 8/112) revealed that CTTH tend to be more frequent among WS patients in general. CONCLUSIONS Our study suggests that CTTH represents a physiological maturation-related process. The high prevalence of CTTH among patients with WS indicates that this physiological process may be modified by additional endo- or exogeneous factors.
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Oral toxicity of vigabatrin in immature rats: Characterization of intramyelinic edema. Neurotoxicology 2011; 32:963-74. [DOI: 10.1016/j.neuro.2011.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 11/22/2022]
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Simao GN, Zarei Mahmoodabadi S, Snead OC, Go C, Widjaja E. Abnormal axial diffusivity in the deep gray nuclei and dorsal brain stem in infantile spasm treated with vigabatrin. AJNR Am J Neuroradiol 2010; 32:199-203. [PMID: 20801762 DOI: 10.3174/ajnr.a2224] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We evaluated the DTI changes in the deep gray nuclei and dorsal brain stem, which demonstrated abnormal T2 and/or diffusion signal intensity, in 6 patients with infantile spasm treated with vigabatrin compared with 6 age-matched controls. Regions of interest were placed in the globi pallidi, thalami, and dorsal brain stem; FA, trace, D(‖), and D(⊥) were measured. Patients on vigabatrin had significantly lower FA in both globi pallidi (P = .01) and the dorsal brain stem (P < .01), significantly lower trace in both globi pallidi (P = .01) and the thalami (P = .02 and .01 for right and left, respectively), and significantly lower D(‖) in both globi pallidi (P ≤ .01), the thalami (P < .01), and the dorsal brain stem (P = .03). There were no significant differences in D(⊥) of the globi pallidi, thalami, or dorsal brain stem in patients compared with controls. The findings suggest that axonal changes play a greater role in the observed abnormal signal intensity, with lesser contribution from myelin changes.
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Affiliation(s)
- G N Simao
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
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Pellock JM, Hrachovy R, Shinnar S, Baram TZ, Bettis D, Dlugos DJ, Gaillard WD, Gibson PA, Holmes GL, Nordli DR, O’Dell C, Shields WD, Trevathan E, Wheless JW. Infantile spasms: A U.S. consensus report. Epilepsia 2010; 51:2175-89. [DOI: 10.1111/j.1528-1167.2010.02657.x] [Citation(s) in RCA: 328] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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