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Objective: To compare efficacy and safety of corticosteroids and combined therapy with corticosteroids and vigabatrin in infantile spasm. Study Design: Randomized Controlled Trial. Setting: Department of Neurology, Children’s Hospital and the Institute of Child Health Multan, Pakistan. Period: November 2020 to November 2022. Material & Methods: A total of 320 children of either gender aged 1-24 month with clinical diagnosis of infantile spasm were included. Infants were randomized into either receiving prednisolone (Group-A) or vigabatrin plus prednisolone (Group-B). Demographical information along with treatment outcomes and adverse effects were noted. Final outcomes were labeled at day-180. Results: In a total of 320 children, 170 (53.1%) were male. Overall, the mean age was 1.3±0.5 years while 166 (51.9%) children were aged between 1 to 2 years. A total of 166 (51.9%) children responded to allocated treatment. The response rate was significantly better in Group-B (n=118, 73.8%) versus Group-A (n=48, 30.0%), p<0.0001. Significantly more children in Group-A missed follow-ups in comparison to those in Group-B (11.8% vs. 1.9%, p=0.0006). Mortality was statistically similar in both study groups (2.5% vs. 1.9%, p=0.7023). The most treatment related adverse effect was noted to be increased appetite and/or weight, gastrointestinal symptoms and sleep disturbance in 253 (79.1%), 121 (37.8%) and 117 (36.6%) respectively. Increased appetite and/or weight gain was significantly more in Group-A (p<0.0001). Conclusion: The findings of this study are in support of using combination therapy of prednisolone and vigabatrin instead of monotherapy for patients with infantile spasm as reflected by higher number of responders to therapy. [ABSTRACT FROM AUTHOR]