A 5-month-old girl develops clusters of flexor spasms on awakening. EEG confirms hypsarrhythmia. Examination reveals several hypopigmented oval macules over her back and trunk. The most appropriate first-line drug for her spasms is:
- A Levetiracetam
- B Valproate
- C Vigabatrin ✓
- D Clonazepam
Correct answer: C. Vigabatrin
Explanation
Infantile spasms with hypsarrhythmia plus hypopigmented macules indicate West syndrome secondary to tuberous sclerosis. In tuberous sclerosis-associated spasms, vigabatrin is the preferred first-line agent because it produces markedly higher rates of spasm cessation than ACTH in this subgroup. ACTH remains an accepted first choice for spasms without a structural cause. Levetiracetam and clonazepam are not established first-line agents for infantile spasms.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.