Background- ACTH and vigabatrin combination therapy is superior to ACTH alone in improving the electro clinical outcomes in children with West syndrome. There is no current study in Indian scenario to support this evidence.

Methodology- This was a retrospective study conducted at Pediatric Neurology department, Bharati Hospital, Pune between Jan 2009 to Dec 2017.  Data of 115 diagnosed children of West syndrome between ages of 2 months to 2 years were taken from the hospital registry, finally data of 48 children were enrolled in our study. Children with severe brain malformation, lethal anomaly, contraindication to steroid were excluded from our study.

Results- Out of 115 patients of West syndrome, 70% were below 1 year of age at onset, commonest etiology was perinatal asphyxia (44%) ,88% had global developmental delay and most common EEG pattern was  modified hypsarrythmia (72%). In 25 infants who received ACTH alone:  complete remission seen in 44%, partial response seen in 32% and no response in 24% at 6 weeks. 23 patients who were on combined therapy of ACTH and vigabatrin showed complete remission in 52.2%, Partial response 34.8% and No response in 13% at 6 weeks. Comparing ACTH therapy alone with ACTH and vigabatrin combination therapy odds ratio in terms of complete remission (0.9790), partial remission (1.1330), no remission (0.8796),suggesting statistically insignificant.,

Conclusion- Although this study statistically could not prove better electro-clinical outcomes in children when treated with combination therapy, we need larger multicentric randomized controlled trials to validate our findings in Indian scenario.