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    Presentation 3

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    1 views15 pages

    Presentation 3

    Uploaded by

    deepakmmc

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    VIGABATRIN

    Vigabatrin
    Vigabatrin

    • Adjunctive treatment for infantile spasms and adult


    refractory complex partial seizure
    Vigabatrin Mechanism Vigabatrin

    • Irreversible & competitive binding to GABA


    transaminase.
    Vigabatrin Mechanism Vigabatrin

    • Possibly also might stimulate GABA release.

    • Brain GABA increases by 40% at 2 hours post-


    dose
    Vigabatrin
    Vigabatrin

    • Linear dose relationship


    • Reduces phenytoin level by 20%
    • Dosage adjustment for decreased renal
    clearance
    Vigabatrin
    Vigabatrin Dosing Complex Partial Seizures

    • Adults: Initial: 500 mg twice daily; increase


    daily dose by 500 mg at weekly intervals
    based on response and tolerability.
    Recommended dose: 3 g/day
    • Children: Oral: Initial: 40 mg/kg/day divided
    twice daily; maintenance dosages based on
    patient weight
    Vigabatrin Dosing Infantile Spasm Vigabatrin

    • Initial dosing: 50 mg/kg/day divided twice


    daily; may titrate upwards by 25-50
    mg/kg/day every 3 days to a maximum of 150
    mg/kg/day
    Vigabatrin
    Vigabatrin Effectively Treats Tuberous Sclerosis

    Practice Parameter: Medical Treatment of


    Infantile Spasms:
    “Overall cessation of spasms was seen in 41 of
    45 (91%) of children treated with vigabatrin,
    with a 100% response rate seen in five
    studies.”
    Vigabatrin
    Vigabatrin Visual Adverse Effects

    • Bilateral irreversible concentric peripheral


    field defects occur in 30-50% of cases
    • Most with defects were treated for at least 6
    months; often stable after 2 years
    • Defects often asymptomatic but might impair
    driving.
    Vigabatrin
    Vigabatrin Visual Adverse Effects

    • Adults: visual testing done at baseline & each


    6 months
    • Infants: visual testing done at baseline & test
    each 3 months for 18 months, then each 6
    months (sedate for electroretinogram)
    Vigabatrin
    Vigabatrin Visual Effects

    • Common approach is treatment for a duration


    under 3 months; consider discontinuation
    after 6 months, if seizures are effectively
    controlled.
    • An experimental animal study found that
    taurine prevented the visual adverse effect
    Vigabatrin
    Vigabatrin White Matter Changes

    • Lesions were asymptomatic & reversible


    • Age: 9 months - 18 years (median 5.4 yrs)
    • 8 of 23 (34%) subjects were affected
    • Brain scans show lesions in basal ganglia,
    thalamus, brainstem, & dentate nucleus.
    Vigabatrin
    Vigabatrin White Matter Changes
    Vigabatrin
    Vigabatrin Summary

    Positive
    • High effectiveness for infantile spasms
    • Few significant drug interactions; exception is
    phenytoin
    • Infrequent need for serum drug levels
    • Low protein binding

    Negative
    • Irreversible visual field defects due to peripheral
    retinal atrophy.
    • White matter lesions
    • Behavioural changes
    • Weight gain, amnesia
    • High cost
    Vigabatrin
    Role of Vigabatrin

    • Vigabatrin is likely to be among the last


    choices for adjuvant treatment of simple and
    complex partial seizures.
    • Can also be used in generalised seizures.
    • Vigabatrin is a good 1st choice for infantile
    spasms from tuberous sclerosis (TS).

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