POMC and Encephalopathy: The findings in the VGB-associated brain abnormalities on MRI (VABAM) include diffusion restriction in the globus pallidus, the corpus callosum, the thalamus, the cerebellar dentate nuclei, the midbrain, and the brainstem; some patients are asymptomatic (more common), and others develop dyskinesias or acute encephalopathy.31Vigabatrin associated with ACTH increases the risk of fulminant VABAM, especially using high doses of ACTH.31Symptoms are reversible after the reduction or discontinuation of the drug, but there are reports of fatal encephalopathy.31, 32, 33