COMPARATIVE ANALYSIS OF STANDARD VS HIGH DOSE STEROID VS VIGABATRIN IN TREATMENT OF INFANTILE SPASMS: A SHORT- TERM OUTCOME BASED STUDY

Abstract

Objective: To compare the short-term outcomes of standard-dose prednisolone, high-dose prednisolone and vigabatrin in children with infantile spasms.

Study Design: Quasi-experimental study

Place and Duration of Study: Department of Pediatric Neurology, The Children’s Hospital, Lahore, from October 2024 to March 2025.

Materials and Methods: Sixty-six children aged 3-24 months with infantile spasms using non probability consecutive sampling were enrolled and allocated into three groups: standard-dose prednisolone (2 mg/kg/day), high-dose prednisolone (10 mg per dose four times daily) and vigabatrin (dose titrated up to 150 mg/kg/day). Outcomes were assessed on day 14 in terms of effectiveness (complete response) and adverse effects.

Results: Out of total 66 patients, the majority of the patients were males, younger than 12 months, had an illness duration longer than one month and were predominantly from urban areas. CNS infections were the most frequent underlying etiology among three groups. Developmental delay was observed in majority of patients. Effectiveness was achieved in 63.6% of children in the high-dose group compared to 27.3% in both the standard-dose group and vigabatrin group (p=0.017). Adverse effects were more common in steroid groups, including weight gain, hypertension, irritability, hyperglycemia, and infections. In contrast no adverse effects were observed in the vigabatrin group (p=0.230).

Conclusion: High-dose prednisolone was significantly more effective than standard-dose prednisolone and vigabatrin in achieving spasm resolution at day 14, with an acceptable adverse effect profile. Vigabatrin showed lower efficacy but was well tolerated.