Treatment of West syndrome with vigabatrin: Reversible MRI signal changes

Tratamento da síndrome de west com vigabatrina: alterações de sinais reversíveis na ressonância magnética

IMAGES IN NEUROLOGY

Treatment of West syndrome with vigabatrin: Reversible MRI signal changes

Tratamento da síndrome de west com vigabatrina: alterações de sinais reversíveis na ressonância magnética

Arnolfo de Carvalho Neto^{I, II}; Luiz Otávio de Mattos Coelho^I; Sergio Eiji Ono^I; Ana Chrystina de Souza Crippa^II

^IDAPI, Diagnóstico Avançado por Imagem, Curitiba PR, Brazil

^IIHospital de Clínicas da Universidade Federal do Paraná, Curitiba PR, Brazil

^{Correspondence}

A 7-month-old with West syndrome was being treated with vigabatrin and a MRI scan was requested to rule out other possible pathologies. The examination revealed typical abnormalities described in the literature with the use of this drug^1-4. Vigabatrin was discontinued and follow-up scan showed signal normalization (Figure). This imaging pattern with the use of vigabatrin is more commonly seen in younger infants (<12 months), patients with cryptogenic infantile spasms¹ and treatment using relatively high dose of this drug^2,3. To explain the changes in the diffusion imaging a recent study analyzed the diffusion tensor, but did not reach a definite conclusion if the changes are attributed to myelin abnormalities or to axonal damage⁴. The imaging pattern described here should be promptly recognized by the neuroradiologist in the appropriate context and the treatment using this drug should be discontinued.

Received 2 June 2011.

Received in final form 15 July 2011.

Accepted 22 July 2011.

• 1. Dracopoulos A, Widjaja E, Raybaud C, Westall CA, Snead OC. Vigabatrin-associated reversible MRI signal changes in patients with infantile spasms. Epilepsia 2010;51:1297-1304.
• 2. Pearl PL, Vezina LG, Saneto RP, et al. Cerebral MRI abnormalities associated with vigabatrin therapy. Epilepsia 2009; 50:184-194.
• 3. Thelle T, Gammelgaard L, Hansen JK, Ostergaard JR. Reversible magnetic resonance imaging and spectroscopy abnormalities in the course of vigabatrin treatment for West syndrome. Eur J Paediatric Neurology 2011; 15:260-264.
• 4. 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 2011;32:199-203.

Publication Dates

• Publication in this collection
  27 Jan 2012
• Date of issue
  Dec 2011