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Vigabatrin aggravates absences and absence status

Vigabatrin is highly effective against partial seizures with or without secondary generalization.1 Vigabatrin increases the inhibitory neurotransmitter GABA in the brain through an irreversible inhibition of GABA-transaminase.1 Thus, it enhances GABAergic transmission mediated by both GABAA and GABAB receptors. However, excessive GABAB activation aggravates absences,2,3 which explains the detrimental effect of vigabatrin in absences and absence status in animals3 and humans.4,5

We present two patients with idiopathic generalized epilepsy in whom vigabatrin increased the frequency and severity of absences and absence status.

Patient 1. A 34-year-old man presented who had onset of absences, absence status, and generalized tonic-clonic seizures (GTCS) at age 16 years. Absences were mild with brief lapses of concentration and a quick flicker of the eyeballs upward. Absence status manifested with mental slowing: "I am able to understand but require some effort and take much longer to formulate my response, …