Peer-reviewed article
Serum matrix metallopeptidase-9 levels in patients with infantile epileptic spasms syndrome before and after the initiation of vigabatrin therapy.
Matsuura R, Hamano SI, Daida A, Oba A, Horita H et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined blood markers of blood-brain barrier function in 12 infants with infantile epileptic spasms syndrome before and after treatment with vigabatrin. The researchers found that a protein called MMP-9 was elevated in infants with the condition compared to healthy controls. After vigabatrin treatment, MMP-9 levels decreased significantly, particularly in infants whose seizures stopped. The findings suggest that vigabatrin may help restore normal blood-brain barrier function in this serious childhood seizure disorder.
Key points
- Serum MMP-9 levels were significantly higher in patients with IESS than in age-matched controls (p < 0.001)
- After vigabatrin therapy initiation, serum MMP-9 levels decreased significantly from 308 ng/mL to 220 ng/mL (p < 0.01)
- MMP-9/TIMP-1 ratio also decreased significantly after treatment (p < 0.05)
- MMP-9 levels decreased in 9 of 11 patients whose epileptic spasms had disappeared
- Findings suggest vigabatrin may improve blood-brain barrier dysfunction in IESS
Limitations
The study included a small sample size (n = 12 patients), which limits generalisability. The lack of a randomised comparison group means the study cannot definitively establish that vigabatrin itself caused the MMP-9 changes rather than natural disease progression or other factors.
Abstract
Purpose Epileptic spasms are the predominant seizure type in infantile epileptic spasms syndrome (IESS). The pathophysiology of IESS, including blood-brain barrier (BBB) function involvement, remains unclear. To address this issue, we evaluated the serum matrix metallopeptidase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in patients with IESS before and after initiating vigabatrin therapy. Methods IESS was defined as epileptic spasms occurring within 2 years after birth. We prospectively assessed serum MMP-9 and TIMP-1 levels before and after initiating vigabatrin therapy in patients with IESS who attended Saitama Children's Medical Center between February 2019 and December 2024 (n = 12; 5 boys) and compared them with those in age-matched controls (n = 14; 8 boys). Results The median ages at epileptic spasm onset and vigabatrin therapy initiation were 3.5 (1-11) and 8 (3-13) months, respectively. Serum MMP-9 levels were higher in patients with IESS than in the controls (p < 0.001). Serum MMP-9 and MMP-9/TIMP-1 ratios decreased significantly after vigabatrin therapy (MMP-9: 308 [160-664] ng/mL vs. 220 [112-367] ng/mL, p < 0.01; MMP-9/TIMP-1 ratio: 1.48 [0.61-8.14] vs. 1.11 [0.31-1.92], p < 0.05). MMP-9 levels decreased in 9 of 11 patients whose epileptic spasms had disappeared by the time of the last measurement. Conclusion Decreased MMP-9 levels after the initiation of vigabatrin therapy suggested an improvement in BBB dysfunction. Our findings shed light on the role of the BBB in IESS and the role of vigabatrin in the recovery of this function.