Vigabatrin Evaluated for Focal Seizures in Tuberous Sclerosis

Vigabatrin is well-established as the first-line therapy for infantile spasms
Vigabatrin is well-established as the first-line therapy for infantile spasms

For patients with focal seizures due to tuberous sclerosis, treatment with vigabatrin may be an effective option for those who have had an inadequate response to other anti-seizure treatments while awaiting epilepsy surgery, according to research presented at the AES Annual Meeting 2017.

Vigabatrin is already an established first-line treatment for infantile spasms in association with tuberous sclerosis but not much is known about its role in focal seizures due to tuberous sclerosis. Study authors from Children's National Health System sought to evaluate their institutional use of vigabatrin for focal seizures in tuberous sclerosis and to assess outcomes through a retrospective review.

Within the tuberous sclerosis database (n=112), 22 patients had received vigabatrin for focal seizures; median age of patients at time of initiation was 8 months (range: 4 months to 9 years). A history of infantile spasms was seen in 86% (19/22) of patients and all except the 2 oldest patients received vigabatrin for infantile spasms. 

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Sixteen patients continued vigabatrin therapy for focal seizures; one patient was non-compliant after resolution of infantile spasms and was restarted on vigabatrin for intractable focal seizures.

The authors reported improvement in 18 of the 22 in the patient cohort (82%) with a mean treatment duration of 5.7 years (range 0.25 to 17 years). Seven patients are still continuing to take vigabatrin; discontinuation in the remaining patients was due to: concern for vision loss (n=9), epilepsy surgery (n=3), ineffective vigabatrin (n=2), and a switch to an alternative anti-seizure medication (n=1). 

Lead author John M. Schreiber noted, "Families often preferred to remain on vigabatrin despite the risk to vision." Although the safety risk of vision loss due to photoreceptor toxicity hinders long-term treatment, vigabatrin may be an effective treatment for focal seizures in tuberous sclerosis, the authors concluded.

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Reference

Schreiber JM, Elling N, Zelleke T, Gaillard WD, and McClintock W. Vigabtrin for focal seziures in tuberous sclerosis. Presented at AES annual meeting in Washington, DC. Abstract 3.88.