Binasal visual field defects are not specific to vigabatrin

González, Pilar Cerezo; Sills, Graeme J.; Parks, S.; Kelly, Kevin; Stephen, Linda J.; Keating, David; Dutton, Gordon N.; Brodie, Martin J.

doi:10.1016/j.yebeh.2009.09.003

Cited by 19 publications

(14 citation statements)

References 21 publications

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“…This probability is supported by the findings of a prospective cohort study by Gonzalez et al (15), in which bilateral visual field constriction (by static perimetry) was not restricted to patients exposed to vigabatrin but also was detected in vigabatrinnaı¨ve patients who received treatment with other GABAergic AED therapy. A total of 204 adults with focal-onset epilepsy were grouped based on AED exposure: patients who had been receiving vigabatrin therapy for at least 1 year (Group 1), patients who had previous exposure to vigabatrin for at least 1 year but had not received it for at least 2 years (Group 2), vigabatrin-naı¨ve patients who were receiving treatment with other GABAergic AEDs (Group 3), and vigabatrin-naı¨ve patients receiving non-GABAergic AEDs (Group 4).…”

Section: Potential Confounding Factorssupporting

confidence: 55%

“…The investigators speculated that two effects on the visual system could be at play: (i) the pathologic effect on retinal function (toxicity) and (ii) the physiologic effect of dampening of the visual system owing to the inhibitory nature of AEDs, which may lead to the development of a pVFD. They observed that AED-associated binasal field defects in patients with epilepsy appear to be compounded by a toxic effect of vigabatrin on retinal function, which would explain the increased frequency of pVFDs in patients exposed to vigabatrin (15). In a review of estimates of vigabatrin-associated pVFDs from a number of studies, Lawden (21) calculated an overall visual field constriction prevalence of 34% (265 of 790) in patients exposed to vigabatrin compared with a prevalence of 4% (10 of 249) in patients receiving other AEDs (Table 1).…”

Section: Methods Of Measurementmentioning

confidence: 99%

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Understanding and interpreting vision safety issues with vigabatrin therapy

Plant

Sergott

2011

Acta Neurologica Scandinavica

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Plant GT, Sergott RC. Understanding and interpreting vision safety issues with vigabatrin therapy. Acta Neurol Scand: 2011: 124 (Suppl. 192): 57–71. © 2011 John Wiley & Sons A/S. Vigabatrin is an irreversible inhibitor of γ‐aminobutyric acid (GABA) transaminase. It is effective as adjunctive therapy for adult patients with refractory complex partial seizures (rCPS) who have inadequately responded to several alternative treatments and as monotherapy for children aged 1 month to 2 years with infantile spasms. The well‐documented safety profile of vigabatrin includes risk of retinopathy characterized by irreversible, bilateral, concentric peripheral visual field constriction. Thus, monitoring of visual function to understand the occurrence and manage the potential consequences of peripheral visual field defects (pVFDs) is now required for all patients who receive vigabatrin. However, screening for pVFDs for patients with epilepsy was conducted only after the association between vigabatrin and pVFDs was established. We examined the potential association between pVFDs and epilepsy in vigabatrin‐naïve patients and attempted to identify confounding factors (e.g., concomitant medications, method of vision assessment) to more accurately delineate the prevalence of pVFDs directly associated with vigabatrin. Results of a prospective cohort study as well as several case series and case reports suggest that bilateral visual field constriction is not restricted to patients exposed to vigabatrin but has also been detected, although much less frequently, in vigabatrin‐naïve patients with epilepsy, including those who received treatment with other GABAergic antiepileptic therapy. We also reviewed published data suggesting an association between vigabatrin‐associated retinal toxicity and taurine deficiency, as well as the potential role of taurine in the prevention of this retinopathy.

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Section: Potential Confounding Factorssupporting

confidence: 55%

Section: Methods Of Measurementmentioning

confidence: 99%

Understanding and interpreting vision safety issues with vigabatrin therapy

Plant

Sergott

2011

Acta Neurologica Scandinavica

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“…Recently, Gonzalez et al [33] described nasal visual field defects in patients exposed to alternative GABAergic antiepileptic drugs, and also in seizure patients never exposed to GABAergic drugs. As a consequence, they questioned the specificity of binasal visual field defects with respect to vigabatrin exposure.…”

Section: Discussionmentioning

confidence: 99%

Modelling the topography of absolute defects in patients exposed to the anti-epileptic drug vigabatrin and in normal subjects using automated static suprathreshold perimetry of the entire 80° visual field

Besch

Schiefer

Eter

et al. 2011

Graefes Arch Clin Exp Ophthalmol

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According to this retrospective study, the spatial configuration of absolute defects attributable to vigabatrin indicates sparing of the temporal field up to approximately 60° eccentricity. Such a finding is likely to explain, at least in part, the initially asymptomatic nature of the defect. This study reconfirms a (cumulative) dose effect of vigabatrin on the extent of absolute field loss, with a greater risk for male gender.

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“…This finding indicates that VGB-related VF defects may be a result of inner retinal dysfunction. Gonzalez et al [17] investigated visual defects associated with VGB with the use of static perimetry and WF-mfERG in 204 epileptic patients with and without exposure to VGB. Interestingly, bilateral VF defects were observed in almost half of the patients with VGB use and in 24% of patients never exposed to the drug, but abnormal ERG was detected only in patients with exposure to VGB.…”

Section: Vgb Retinopathymentioning

confidence: 99%

“…Approximately 90º of the retina can be detected with the use of WF-mfERG, whereas the testing field of conventional mfERG is around 40-50° [4]. It is used in assessing peripheral retinal dysfunction in patients with retinitis pigmentosa [14], retinal vein occlusion [15], birdshot chorioretinitis [16] and vigabatrin (VGB) toxicity [17,18]. …”

Section: Introductionmentioning

confidence: 99%

The Role of Multifocal Electroretinography in the Assessment of Drug-Induced Retinopathy: A Review of the Literature

Dettoraki

Moschos²

2016

Ophthalmic Res

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Multifocal electroretinography (mfERG) is an objective, noninvasive examination for the assessment of visual function. It enables the stimulation of multiple retinal areas simultaneously and recording of each response independently, providing a topographic measure of retinal electrophysiological activity in the central 40-50° of the retina. A clinical application of mfERG represents the assessment of retinal toxicity associated with systemic medications. Drug-induced retinopathy represents a disease that, although not common, requires early recognition: if not detected early, it may progress and cause irreversible retinal dysfunction with subsequent visual impairment. This review aims to evaluate the use of mfERG in the assessment of retinal dysfunction associated with various systemic pharmacological agents based on the currently available literature. The most commonly recognized systemic medications affecting retinal function are included, such as chloroquine and hydroxychloroquine, vigabatrin, deferoxamine, ethambutol, interferon-α, tamoxifen, digoxin, sildenafil, canthaxanthin, amiodarone and nefazodone. The role of mfERG in the early diagnosis of retinal toxicity and the evaluation of disease severity is reviewed, as well as its clinical value in monitoring disease progression or recovery after drug cessation.

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Binasal visual field defects are not specific to vigabatrin

Cited by 19 publications

References 21 publications

Understanding and interpreting vision safety issues with vigabatrin therapy

Understanding and interpreting vision safety issues with vigabatrin therapy

Modelling the topography of absolute defects in patients exposed to the anti-epileptic drug vigabatrin and in normal subjects using automated static suprathreshold perimetry of the entire 80° visual field

The Role of Multifocal Electroretinography in the Assessment of Drug-Induced Retinopathy: A Review of the Literature

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