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Visual evoked responses in tuberculous children on ethambutol therapy
V Seth1, P K Khosla, O P Semwal
1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Insights
Children treated with ethambutol for tuberculosis showed no significant changes in visual evoked responses (VERs). This suggests ethambutol is safe for pediatric use, with no increased risk of optic damage compared to adults.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Pharmacology
Background:
- Tuberculosis treatment in children often involves ethambutol.
- Ethambutol can cause optic toxicity, but data in pediatric populations is limited.
- Assessing subclinical optic nerve toxicity is crucial for safe pediatric treatment.
Purpose of the Study:
- To evaluate the potential for ethambutol-induced optic nerve damage in children.
- To assess changes in visual evoked responses (VERs) during and after ethambutol therapy.
- To compare the risk of optic toxicity in children versus adults.
Main Methods:
- Recorded visual evoked responses (VERs) in 47 children (3-13 years) with tuberculosis.
- Administered ethambutol (20 mg/kg/day) as part of antitubercular therapy.
- Monitored VERs at multiple time points before, during, and after treatment.
Main Results:
- Mean latency values for VERs remained within normal ranges throughout the study period.
- No statistically significant differences in VER latency were observed at any time point.
- Latency values in children were comparable to those typically seen in adults.
Conclusions:
- Ethambutol at the studied dosage does not appear to cause significant subclinical optic toxicity in children.
- The drug can be safely included in pediatric antitubercular regimens without undue concern for optic nerve damage.
- Pediatric patients may not be at a higher risk for ethambutol-induced optic toxicity than adults.
Abstract:
Visual evoked responses (VERs) were recorded in 47 children, aged 3-13 years with tuberculosis, treated with ethambutol (20 mg/kg/day) as a part of the antitubercular regimen. VERs were evoked by monocular whole field stimulation, the stimulus being provided by a black and white checker-board pattern reversed every 560 msec and recorded before the commencement, 2, 4, 6, 9 and 12 months of therapy and between 3 to 6 months after stopping the drug. In the first 6 months of therapy the mean values of latency ranged from 92.8 to 101.3 msec in the 3 to less than 6 years age group and 88.5 to 100.3 msec in children 6-13 years of age. Between 6-12 months of therapy the mean values of latency were between 93.3 to 101.0 msec in the 3 to less than 6 years age group and 96.0 to 101.5 msec in the older group. Between 3-6 months after stopping therapy the means of latency ranged from 92 to 96 msec. The differences were not statistically significant at any point of time. Thus, children do not seem to be at greater risk for developing ethambutol inducted optic damage as compared to adults. Ethambutol in the above stated dose may, therefore, be recommended for inclusion in antitubercular chemotherapy in pediatrics without undue fear of subclinical toxicity.