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Clinical Utility of Electroretinograms for Evaluating Vigabatrin Toxicity in Children
Insights
Electroretinogram (ERG) screening for vigabatrin-induced retinal toxicity in children rarely altered clinical treatment. Given the need for anesthesia and limited impact, ERG screening in this population warrants reconsideration.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Clinical Toxicology
Background:
- Vigabatrin is used for pediatric seizure control.
- Vigabatrin carries a risk of retinal toxicity.
- Electroretinogram (ERG) is used for screening this toxicity.
Purpose of the Study:
- To evaluate changes in clinical management of pediatric patients on vigabatrin based on ERG screening results for retinal toxicity.
Main Methods:
- Retrospective review of medical records of pediatric patients who underwent ERG between 2009-2012.
- Data extracted included patient age, ERG indication, ERG results, and vigabatrin management.
- ERG interpretation followed LKC Technologies normative values by a trained physician.
Main Results:
- Out of 170 ERGs, 147 were analyzed; 30 ERGs were for vigabatrin toxicity screening.
- Of those screened for toxicity, 93.3% showed abnormal ERG results.
- Only one patient discontinued vigabatrin despite abnormal ERG findings.
Conclusions:
- Clinical management of pediatric patients on vigabatrin was minimally altered by abnormal ERG screening results.
- The necessity of general anesthesia for pediatric ERG and limited impact on treatment suggest reconsidering routine ERG screening for vigabatrin toxicity.
Purpose:
To determine changes in the clinical treatment of pediatric patients taking vigabatrin for seizure control in response to results of electroretinogram (ERG) performed for retinal toxicity screening.
Methods:
The authors retrospectively reviewed the medical records of patients who received ERGs at Children's Hospital of Colorado from 2009 to 2012. Age, indication for ERG, ERG data, and clinical management of vigabatrin were extracted from the records. ERGs were interpreted according to LKC Technologies normative values. A physician trained in ERG analysis interpreted each ERG.
Results:
One hundred seventy ERGs were performed during the study period, and 147 ERGs were available for analysis. Every patient received general anesthesia for the procedure. Thirty-three ERGs were performed in 29 patients specifically as screening for retinal toxicity due to vigabatrin use, and 30 were available for analysis. Within this cohort, only 2 ERGs were normal (6.6%), and 28 were abnormal (93.3%). In patients who received abnormal results, 1 patient discontinued vigabatrin in response to the screening.
Conclusions:
In this study cohort, clinical management generally did not change in response to an abnormal screening result. Given the need for general anesthesia in the pediatric population receiving ERG testing, and minimal change in clinical decision-making in the face of abnormal results, ERG screening for retinal toxicity due to vigabatrin in the pediatric cohort should be reconsidered. [.
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