TSC Infantile Spasms – Vigabatrin — SCE Neurology MCQ

Correct answer: A — Vigabatrin, adding prednisolone after one week if needed

The best answer is “Vigabatrin, adding prednisolone after one week if needed”. NICE distinguishes infantile spasms caused by tuberous sclerosis: vigabatrin is first line, urgent specialist follow-up and sleep EEG assess response, and high-dose prednisolone is added if spasms persist after one week. “Carbamazepine monotherapy with review after three months” is less appropriate because carbamazepine is not the recommended first-line therapy for this epileptic encephalopathy “Long-term phenobarbital without tertiary paediatric neurology involvement” is less appropriate because urgent tertiary expertise and response monitoring are required “Observation because infantile spasms are developmentally benign” is less appropriate because untreated spasms carry major developmental risk “Ethosuximide as treatment for a focal structural epilepsy” is less appropriate because ethosuximide is used for absence seizures and does not address this syndrome

Reference: NICE NG217: Epilepsies in children, young people and adults. https://www.nice.org.uk/guidance/ng217/chapter/Recommendations