Vigabatrin Versus Adrenocorticotropic Hormone After High-Dose Prednisolone Failure for the Treatment of Epileptic Spasms

Infantile epileptic spasms syndrome carries high morbidity and mortality compared with other childhood epilepsy syndromes. High-dose prednisolone is considered the first-line option by many neurologists, with efficacy comparable to adrenocorticotropic hormone (ACTH).  The second-line therapy is debated if prednisolone fails to induce remission. The objective of this study was to evaluate the efficacy of adrenocorticotropic hormone versus vigabatrin as second-line antiseizure medication in patients with infantile epileptic spasms syndrome after high-dose prednisolone failure. Thirty-eight patients met the inclusion criteria. Seventeen patients (45%) took vigabatrin and 21 (55%) took adrenocorticotropic hormone. There were no significant differences regarding age of infantile spasms onset (P = .37) or sex between both groups (P = .32). Complete control of epileptic spasms was seen in 5 of 17 patients (29.5%) taking vigabatrin and in 4 of 21 (19%) taking adrenocorticotropic hormone (P = .70). Vigabatrin showed higher efficacy; however, it did not reach statistical significance, possibly because of our sample size. These results may help guide family counseling after the failure of high-dose prednisolone as first-line therapy.