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Case Reports
. 2025 Jul 23;17(7):e88593.
doi: 10.7759/cureus.88593. eCollection 2025 Jul.

Imaging Findings of Vigabatrin-Associated Neurotoxicity in a 12-Month-Old With Infantile Epileptic Spasm Syndrome

Jennifer Nedimyer Horner  1 , Mohamad A Asfour  2 , Gleidson Silva  3 , Tushar Chandra  3
Affiliations
Case Reports

Imaging Findings of Vigabatrin-Associated Neurotoxicity in a 12-Month-Old With Infantile Epileptic Spasm Syndrome

Jennifer Nedimyer Horner et al. Cureus. .

Abstract

Infantile epileptic spasm syndrome (IESS), also known as West syndrome, is a rare and severe form of epileptic encephalopathy of infancy. Vigabatrin, a selective, irreversible inhibitor of gamma-aminobutyric acid transaminase (GABA-T), is currently the only FDA-approved medication for the management of IESS. Known associations include neurotoxicity and visual defects. A 12-month-old female with a history of developmental delay and IESS, currently being treated with vigabatrin, was evaluated with magnetic resonance imaging (MRI) after presenting with excessive drowsiness and poor feeding. Imaging findings were significant for new areas of restricted diffusion involving the anterior commissure, medial aspect of the globi pallidi, and the medial thalami bilaterally compared to the patient's MRI prior to starting vigabatrin. These findings suggested vigabatrin neurotoxicity. This case demonstrates the clear relationship between vigabatrin use and the development of stereotypical imaging abnormalities associated with neurotoxicity. It also further illustrates the importance of early recognition and withdrawal of therapy in order to prevent potential long-term side effects.

Keywords: anterior commissure; globi pallidi; infantile epileptic spasm syndrome; medial thalami; mri; neuroradiology; neurotoxicity; restricted diffusion; vigabatrin; west syndrome.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Axial and coronal DWI and ADC brain MRI of the anterior commissure
Axial and coronal images demonstrate hyperintense signal on DWI (a and b) and loss of signal on ADC (c and d) in the bilateral anterior commissure (red arrows) to suggest restricted diffusion. DWI: diffusion-weighted imaging; ADC: apparent diffusion coefficient
Figure 2
Figure 2. Axial and coronal DWI and ADC brain MRI of the thalami
Axial and coronal images demonstrate hyperintense signal on DWI (a and b) and loss of signal on ADC (c and d) in the bilateral paramedian thalami (red arrows) to suggest restricted diffusion. DWI: diffusion-weighted imaging; ADC: apparent diffusion coefficient
See this image and copyright information in PMC

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