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Visual function is stable in patients who continue long-term vigabatrin therapy: implications for clinical decision
S R Paul1, G L Krauss, N R Miller
1Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Epilepsia
|July 7, 2001
Summary
Continuing vigabatrin (VGB) therapy for over two years is safe for patients with mild visual changes, with regular monitoring. Alternative therapies effectively manage seizures in patients discontinuing VGB.
Area of Science:
- Neurology
- Ophthalmology
Background:
- Vigabatrin (VGB) is associated with visual dysfunction, including visual field constriction.
- Prolonged VGB treatment necessitates understanding its long-term safety profile.
Purpose of the Study:
- To assess the safety of continuing long-term vigabatrin therapy in epilepsy patients.
- To monitor visual function changes over one year of continued VGB treatment.
- To evaluate the efficacy of alternative antiepileptic drugs (AEDs) in patients discontinuing VGB.
Main Methods:
- Serial visual function testing (visual acuity, color vision, perimetry) every 3 months for one year in patients continuing VGB.
- Monitoring seizure response in patients discontinuing VGB and starting alternative AEDs for at least 3 months.
Main Results:
- No significant worsening of visual acuity, color vision, or visual field constriction was observed in patients continuing VGB therapy.
- Many patients who stopped VGB achieved good seizure control with alternative AEDs, including previously ineffective ones.
Conclusions:
- Continued vigabatrin therapy may be safe for patients with excellent seizure response and only mild visual changes, provided close visual monitoring.
- Alternative antiepileptic drugs are effective for patients experiencing significant seizures or considerable visual dysfunction with VGB.