Visual Field Loss in Patients with Refractory Partial Epilepsy Treated with Vigabatrin

Abstract

Since the probability of VAVFL is positively associated with treatment duration, careful assessment of the risk-benefit ratio of continuing treatment with vigabatrin is recommended in patients currently receiving this drug. All patients continuing to receive vigabatrin should undergo visual field examination at least every 6 months for the duration of treatment. We recommend two-level (three-zone), gradient-adapted, suprathreshold static perimetry of the peripheral field together with threshold perimetry of the central field out to 30 degrees from fixation. The frequency of ophthalmological and perimetric examinations should be increased in the presence of VAVFL.

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

“…Nevertheless, severe visual field constriction to <30° of retained monocular temporal visual field, corresponding to a total extent of binocular vision of <60°, occurred in 2% of patients. In spite of the differences between the analyses, Wild and colleagues (Wild et al, 2009) found that 15 of 386 patients (4%) in Groups I and II had severe vigabatrin-attributed visual field loss, which is similar to the findings of our present analysis. However, in contrast to the analysis of Wild and colleagues (Wild et al, 2009), we found a weak correlation between answering "yes" to at least 1 question on the visual function questionnaire and severity of the visual field defect.…”

“…The current paper complements the previously published analysis of this same study (Wild et al, 2009). This analysis employed quantitative measurements of the visual field along the horizontal meridian from kinetic perimetry to estimate the severity of visual field defects.…”

“…The criterion of <30° for a severe deficit is similar to that chosen for several published studies based on kinetic perimetry. Importantly, the categories employed here are not commensurate with those 16 employed by Wild et al (Wild et al, 2009). Moreover, the duration of vigabatrin exposure was somewhat shorter in the subgroup of patients undergoing Goldmann perimetry than in the entire study population.…”

“…In these analyses, the primary outcome measure, the presence or absence of bilateral, concentric, peripheral constriction (BCPC) of the visual fields, was based on a global assessment of the perimetry data for each patient through partially specified criteria and predominantly static perimetry. The analysis of the final data set found that, among 524 evaluable patients with 1 or more conclusive perimetry examinations, the frequency of BCPC at the last conclusive examination was greatest for patients receiving vigabatrin at study entry: 26.3% for patients aged 8-12 years and 43.3% for patients aged >12 years (Wild et al, 2009 …”

Comparative Analysis of Therapy Outcomes in Patients With West Syndrome Receiving Tetraсosactidе and Other Antiepileptic Drugs

“…Эти исследования проде-монстрировали, что вигабатрин эффективен в лече-нии инфантильных спазмов в большинстве случаев независимо от их этиологии, но все же наибольшую эффективность данный препарат продемонстрировал у пациентов с туберозным склерозом. Вигабатрин, как правило, хорошо переносился, однако его исполь-зование было связано с нарушением периферического зрения у части пациентов [21]. По данным американ-ских исследователей, у детей с туберозным склерозом вигабатрин следует рассматривать в качестве препа-рата начальной терапии инфантильных спазмов [11].…”