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Vigabatrin associated retinal dysfunction in children with epilepsy
1Department of Child Health, Division of Paediatric Neurology, Sultan Qaboos University Hospital, Al Khod, 123, Sultanate of Oman. rkoul@omantel.net
Insights
Vigabatrin can cause vision problems in children with epilepsy. Regular eye exams and tests like electroretinography are recommended to monitor for these vigabatrin-induced eye changes.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Vigabatrin is a medication used to treat seizures.
- Recent studies indicate potential eye abnormalities in patients undergoing vigabatrin treatment.
Purpose of the Study:
- To prospectively identify and document eye changes in children treated with vigabatrin for seizures.
- To assess the incidence and nature of visual disturbances associated with vigabatrin therapy in pediatric epilepsy patients.
Main Methods:
- A prospective study followed 29 children on vigabatrin for an average of 6.5 years.
- Ophthalmic examinations were conducted before treatment initiation and every six months thereafter.
- Visual evoked potentials (VEPs) were assessed, though electroretinography (ERG) and electro-oculography (EOG) were not consistently available.
Main Results:
- Of 21 children meeting inclusion criteria, 19% developed eye changes including retinal pigmentation, hypopigmented spots, vascular sheathing, and optic atrophy.
- Abnormal visual evoked potentials (VEPs) were observed in 16 children.
- The mean vigabatrin dose was 55.8 mg/kg/day, with a mean therapy duration of 35.7 months.
Conclusions:
- Vigabatrin treatment is associated with significant eye damage in pediatric patients.
- Due to the inability of young children to report visual symptoms, regular ophthalmic monitoring is crucial.
- Recommended follow-up includes 3-6 month ophthalmic check-ups, VEPs, and, if possible, ERG and EOG to detect early signs of vigabatrin-induced retinopathy.
Background:
Recent reports have established that eye changes occur in patients treated with vigabatrin.
Aim:
To identify the eye changes associated with vigabatrin, based on a prospective study of children treated for seizures.
Methods:
Twenty nine children on vigabatrin (mainly as add on therapy) were followed up for 6.5 years. Ophthalmic examination was performed before starting treatment and then six monthly in the outpatient clinic.
Results:
Twenty one children fulfilled the inclusion criteria. Most had epileptic syndromes with infantile spasms-namely West syndrome, Lennox-Gastaut syndrome, and partial seizures. Vigabatrin dose was 25-114 mg/kg/day (mean 55.8); duration of therapy was 6-85 months (mean 35.7). Four children (19%) developed eye changes (retinal pigmentation, hypopigmented retinal spots, vascular sheathing, and optic atrophy). Visual evoked potentials were abnormal in 16 children. Electroretinography and electro-oculography, which could have picked up eye changes in early stages, were not performed, as this facility was not available.
Conclusions:
Vigabatrin causes eye damage. Most children with epileptic syndromes on vigabatrin cannot complain of their eye problems, hence 3-6 monthly ophthalmic follow up is strongly advised, along with regular electroretinography, electro-oculography, and visual evoked potentials if possible.