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Infantile spasms and vigabatrin

BMJ 1999; 318 doi: (Published 02 January 1999) Cite this as: BMJ 1999;318:56

Study will compare effects of drugs

  1. John P Osborne, Professor of paediatrics and child health and chairman of steering committee (,
  2. Stuart W Edwards, Research coordinator,
  3. Eleanor Hancock, Research fellow,
  4. Andrew L Lux, Research fellow,
  5. Finbar O'Callaghan, Lecturer in paediatrics,
  6. Tony Johnson, Statistician,
  7. Colin R Kennedy, Consultant paediatric neurologist,
  8. Richard W Newton, Consultant paediatric neurologist,
  9. Christopher M Verity, Consultant paediatric neurologist
  1. Bath Unit for Research in Paediatrics, Royal United Hospital, Bath BA1 3NG
  2. MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR
  3. Southampton General Hospital, Southampton SO9 4XY
  4. Royal Manchester Children's Hospital, Manchester M27 1HA
  5. Addenbrooke's Hospital, Cambridge CB2 2QQ
  6. Department of Neuroepidemiology, Epilepsy Research Group, National Hospital for Neurology and Neurosurgery and the Institute of Neurology, Queen Square, London WC1N 3BG

    EDITOR—In his letter about the use of vigabatrin in children Appleton reports the consensus guideline from a “paediatric advisory group.”1 The longer version of Appleton's letter (on the BMJ website) includes the information that “the advisory group [was] supported by an educational grant from Hoechst Marion Roussel,” the manufacturer of vigabatrin, but the letter in the paper journal does not say this. The guideline states that “vigabatrin currently remains the drug of choice for infantile spasms.” Many paediatricians and paediatric neurologists, in both the United Kingdom and North America, would dispute this statement and continue to use tetracosactrin (ACTH) or prednisolone (or prednisone) as first choice.

    The only published randomised controlled trial comparing vigabatrin and ACTH as first line treatment in infantile spasms showed cessation of seizures in 48% and 74%, respectively, of 42cases analysed by intention to treat (difference 26% (95% confidence interval−3% to 54%)),2 which seems to exclude a significant treatment advantage for vigabatrin. Side effects (drowsiness, …

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