Vigabatrin-induced peripheral visual field defects in patients with refractory partial epilepsy

Sergott, Robert C.; Bittman, Richard M.; Christen, Erin M.; Sagar, Stephen M.

doi:10.1016/j.eplepsyres.2010.09.004

Cited by 16 publications

(9 citation statements)

References 30 publications

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“…VGB‐induced retinal damage (VGB‐RD) was first reported in 1997 and is characterized by permanent, bilateral constriction of the peripheral visual fields . This visual field loss is asymptomatic for most patients; thus, periodic ophthalmologic testing is required to detect it .…”

Section: Clinical Use Of Vigabatrinmentioning

confidence: 99%

“…In a recent prospective study, Sergott et al. evaluated visual field impairment by Goldmann perimetry in 258 VGB‐treated patients with refractory partial epilepsy. Fifty‐three percent of patients were classified as having mild visual field defects (60–80 ° monocular temporal field retained), 17% had moderate defects (30–60 ° temporal field retained), and 2% had severe defects (<30 ° temporal field retained).…”

Section: Clinical Use Of Vigabatrinmentioning

confidence: 99%

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Vigabatrin-associated retinal damage - potential biochemical mechanisms

Heim

Gidal

2012

Acta Neurol Scand

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Vigabatrin (VGB), an irreversible inhibitor of gamma-aminobutyric acid (GABA) transaminase, is approved as adjunct treatment of refractory partial seizures as well as infantile spasms. Although VGB has been proven to be effective, its use is limited by the risk of retinopathy and associated peripheral visual field defects. This review describes and analyzes current literature related to potential pathophysiologic mechanisms underlying VGB-mediated cellular toxicity. Animal data suggest that GABA mediates neural excitotoxicity. The amino acid taurine is concentrated in retinal cells, and deficiency of this amino acid may be involved in VGB-mediated retinal degeneration and possible phototoxicity.

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Section: Clinical Use Of Vigabatrinmentioning

confidence: 99%

Section: Clinical Use Of Vigabatrinmentioning

confidence: 99%

Vigabatrin-associated retinal damage - potential biochemical mechanisms

Heim

Gidal

2012

Acta Neurol Scand

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“…28 The most discussed side effect of vigabatrin involves peripheral vision defects (mainly bilateral nasal defects) with central vision sparing which is often mild to moderate. The incidence ranges between 14% and 92% of patients 29 and can be permanent. The FDA mandated that children have vision screening at baseline, every 3 months for 18 months, then every 6 months thereafter, while receiving treatment.…”

Section: New Advances In Drug Therapymentioning

confidence: 99%

Pediatric epilepsy

2012

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Epilepsy in children can be very different from epilepsy in adults, both in seizure type and epilepsy syndrome. The goal in treating children is seizure freedom, no treatment side effects, and function that is no different from the general population. In a significant percentage of patients, this goal remains unachievable, but many aspects of epilepsy are becoming clearer. This review will highlight 5 areas where progress is being made to achieve these goals in pediatric epilepsy. Specific research animal models are being developed to reflect the unique features of different pediatric epilepsies. As genetic syndromes are better identified, for some patients this has led to improved treatment. New advances in drug therapy have led to 3 new medications approved for children. More effective drug choices can now be recommended due to comparative drug trials and better overall care of children can be provided due to awareness of the comorbidities of epilepsy.

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“…Unfortunately, vigabatrin can cause direct retinal toxicity leading to constriction of peripheral visual fields, a difficult complication to monitor in non-verbal and pre-verbal children. This impairment occurs in 16-44% of testable patients treated long term, but often remains asymptomatic [12,13]. In the United States, the Food and Drug Administration (FDA) mandates patient counseling, consent, and monitoring of ongoing ophthalmological follow-up.…”

Section: Box 154 American Academy Of Neurology (Aan) and Child Neuromentioning

confidence: 99%

Cryptogenic and Symptomatic Generalized Epilepsies: Epilepsies with Encephalopathy

Keough¹

2012

Epilepsy in Children and Adolescents

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Vigabatrin-induced peripheral visual field defects in patients with refractory partial epilepsy

Cited by 16 publications

References 30 publications

Vigabatrin-associated retinal damage - potential biochemical mechanisms

Vigabatrin-associated retinal damage - potential biochemical mechanisms

Pediatric epilepsy

Cryptogenic and Symptomatic Generalized Epilepsies: Epilepsies with Encephalopathy

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