Cumulative Response of High Dose Steroids and Sequentially Added Vigabatrin in Patients of Infantile west Syndrome in A Resource

Objectives: To assess the cumulative response of very high dose steroids and sequentially added Vigabatrin in patients of infantile West Syndrome. Methods: This was an observational study conducted at a tertiary care hospital from August-2014 to August2015. Children aged 2-23 months presenting with infantile spasms with hypsarrhythmia on EEG were enrolled. The study participants were started on high dose Prednisolone (8 mg/kg/day maximum 60mg/day). Patients who did not respond to this treatment were started on Vigabatrin (50-150mg/kg/day) in sequentially increasing doses and prednisolone treatment was tapered off. The primary outcome measure was cessation of spasms and clearance of hypsarrhythmia on EEG after initiating Vigabatrin in a cohort of non-responders to steroid therapy. The study was approved by the ethical committee of the college. Results: The response of high dose steroid alone was nearly 55.55% (20/36) after 2 weeks therapy which was significantly higher as compared with studies done earlier using similar or lower dose regimes. Out of the nonresponders to very high dose steroid therapy 68.75% (11/16) responded to sequentially added Vigabatrin therapy. Thus at the end of the study cumulative response was 86.11% (31/36) with this combination regime. Conclusion: Using a higher dose steroid therapy there was an increase in response rate. But cumulative response of high dose steroid and sequentially added Vigabatrin was as good as or better than that reported with combination of both therapies in earlier studies.