Vigabatrin-associated toxicity is a potential neurological complication in patients treated with vigabatrin, an antiseizure medication whose mechanism of action includes inhibition of GABA metabolism. It is primarily used as a treatment of focal seizures and infantile spasm disorders (e.g. tuberous sclerosis complex, West syndrome). The potential for neuroimaging abnormalities to develop during treatment is well recognised 1.
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Epidemiology
MRI changes can be seen in approximately 30% of patients with infantile spasms treated with vigabatrin 2,3.
Clinical presentation
Patients with vigabatrin-associated neurotoxicity may be asymptomatic, or may experience 2:
visual disturbances, including permanent visual loss
movement disorders
Radiographic features
MRI
MRI brain is the imaging modality of choice. The most commonly affected areas are the globi pallidi, thalami, dorsal brainstem, and dentate nuclei 1-3. Signal changes are reversible after vigabatrin withdrawal 1-3.
T2/FLAIR: hyperintense
DWI: restricted diffusion
Treatment and prognosis
Management consists of vigabatrin withdrawal 2.
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