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The Hospital for Sick Children, Toronto, Longitudinal ERG study of children on vigabatrin
Carol A Westall1, William J Logan, Kim Smith
1Departments of Ophthalmology, University of Toronto, Ontario, Canada.
Insights
Vigabatrin treatment in children showed a distinct pattern in cone b-wave amplitude, increasing then decreasing over time. Rod responses, however, remained largely unchanged during vigabatrin therapy.
Area of Science:
- Ophthalmology
- Neuroscience
- Clinical Electrophysiology
Background:
- Vigabatrin is an anticonvulsant medication used in pediatric epilepsy.
- Understanding its long-term effects on visual function is crucial.
- Electroretinography (ERG) is a key tool for assessing retinal function.
Purpose of the Study:
- To longitudinally assess changes in ERG responses in children undergoing vigabatrin treatment.
- To compare ERG alterations between vigabatrin monotherapy and combination therapy.
- To identify specific ERG parameters affected by vigabatrin over time.
Main Methods:
- Longitudinal ERG recordings in 33 children before and during vigabatrin treatment.
- Standard ISCEV protocol with Burian-Allen electrodes, including photopic oscillatory potentials (OPs).
- Comparison of ERG data between monotherapy and polytherapy groups over approximately 6-month intervals.
Main Results:
- A significant quadratic change (increase then decrease) in cone b-wave amplitude was observed over time in children on vigabatrin monotherapy.
- Similar patterns were noted in children receiving vigabatrin with additional anticonvulsants.
- Flicker ERG amplitude generally declined between 6 months and 1 year of treatment.
- Rod ERG responses showed no substantial changes related to vigabatrin treatment.
Conclusions:
- Vigabatrin treatment is associated with a time-dependent, non-linear change in cone-mediated ERG responses.
- Rod function appears less affected by vigabatrin compared to cone function.
- Long-term ERG monitoring is valuable for assessing visual system changes during vigabatrin therapy.
Abstract:
The purpose of this longitudinal study was to identify changes in ERG responses associated with vigabatrin treatment. We accomplished this by recording longitudinally ERGs in children before and during vigabatrin treatment and comparing results between children on vigabatrin monotherapy and those taking additional anticonvulsive medications. Thirty-three children on vigabatrin therapy were tested; the duration between visits was approximately 6 months. Thirteen children were assessed initially before starting vigabatrin therapy and seven were assessed soon after (age range 1.5-126 months, median 6 months). The remaining 13 patients were already on vigabatrin at the time of initial visit (age range 6.5-180 months, median 16 months). ERGs were tested using the standard protocol established by the International Society for Clinical Electrophysiology of Vision, with Burian-Allen bipolar contact-lens electrodes. In addition to standard responses we recorded photopic oscillatory potentials (OPs). All 33 patients were tested longitudinally on at least two occasions and 11 were tested on three occasions. For children whose only anticonvulsive drug was vigabatrin there was a significant curvature (quadratic function, p < 0.05) of the predicted cone b-wave amplitude with time; exhibited as increase in b-wave amplitude followed by subsequent decrease. Descriptive data demonstrated the same pattern in the group taking anticonvulsive medications in addition to vigabatrin. In most children the flicker amplitude declined between 6 months and 1 year of vigabatrin treatment. Our data demonstrated that rod responses, which may be abnormal before initiation of vigabatrin, did not change substantially with vigabatrin treatment.