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A 10-month-old boy with global developmental delay presented to clinic with a few months of infantile spasms occurring multiple times a day. His seizures continued despite vigabatrin (dosed at 133 mg/kg/d), levetiracetam, and steroid therapy. On vigabatrin, routine follow-up MRI showed abnormal signal change , which may occur in 30.9% of patients.1 Risk is associated with a high peak dose but not cumulative.2 These findings are largely asymptomatic although rarely patients can present with hyperkinetic disorders.2 The imaging findings resolved on 4-month follow-up after tapering vigabatrin. At 18 months of age, the patient continues to have 1 seizure every 2 weeks.