Treatment of West syndrome with vigabatrin: reversible MRI signal changes.

Received 2 June 2011. Received in final form 15 July 2011. Accepted 22 July 2011. A 7-month-old with West syndrome was being treated with vigabatrin and a MRI scan was requested to rule out other possible pathologies. The examination revealed typical abnormalities described in the literature with the use of this drug. Vigabatrin was discontinued and follow-up scan showed signal normalization (Figure). This imaging pattern with the use of vigabatrin is more commonly seen in younger infants (≤12 months), patients with cryptogenic infantile spasms and treatment using relatively high dose of this drug. To explain the changes in the diffusion imaging a recent study analyzed the diffusion tensor, but did not reach a definite conclusion if the changes are attributed to myelin abnormalities or to axonal damage. The imaging pattern described here should be promptly recognized by the neuroradiologist in the appropriate context and the treatment using this drug should be discontinued.