Color vision in epileptic adolescents treated with valproate and carbamazepine

Verrotti, Alberto; Lobefalo, L.; Priolo, T.; Rapinese, M; Trotta, Daniela; Morgese, G; Gallenga, P. E.; Chiarelli, Francesco

doi:10.1016/j.seizure.2003.09.006

Cited by 27 publications

(28 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In patients treated with a 1-year carbamazepine regimen, central and paracentral colour vision clearly decreased. [117] This effect is not universally accepted, since many trials in humans have not detected such findings. [23] In a cross-sectional study involving 18 patients who had been taking valproate monotherapy for 2-20 years, only minor abnormalities in colour vision were discovered in two patients.…”

Section: Abnormal Colour Perceptionmentioning

confidence: 99%

Ocular Adverse Effects of Common Psychotropic Agents

Richa¹,

Yazbek²

2010

CNS Drugs

178

143

View full text Add to dashboard Cite

All psychotropic medications have the potential to induce numerous and diverse unwanted ocular effects. Visual adverse effects can be divided into seven major categories: eyelid and keratoconjunctival disorders; uveal tract disorders; accommodation interference; angle-closure glaucoma; cataract/pigmentary deposits in the lens and cornea; retinopathy; and other disorders. The disorders of the eyelid and of the keratoconjunctiva are mainly related to phenothiazines and lithium. Chlorpromazine, at high dosages, can commonly cause abnormal pigmentation of the eyelids, interpalpebral conjunctiva and cornea. It can also cause a more worrisome but rarer visual impairment, namely corneal oedema. Lithium can rarely lead to a bothersome eye irritation by affecting sodium transport. Uveal tract problems are mainly associated with tricyclic antidepressants (TCAs), typical antipsychotics, topiramate and selective serotonin reuptake inhibitors (SSRIs). TCAs, typical antipsychotics and SSRIs can all cause mydriasis that is often transient and with no major consequences, but that can promote closure of angles in susceptible patients. Topiramate has been frequently associated with a number of significant ocular symptoms including acquired myopia and angle-closure glaucoma. Problems with accommodation are related to TCAs and to low-potency antipsychotics. TCAs cause transient blurred vision in up to one-third of patients. Angle-closure glaucoma is a serious condition that has been mainly associated with TCAs, low-potency antipsychotics, topiramate and, to a lesser extent, SSRIs. When patients with narrow angles are given TCAs, they all appear to experience induction of glaucomatous attacks. Antipsychotics and SSRIs may lead to an added risk of developing angle-closure glaucoma, but only in predisposed eyes. Topiramate can lead to an allergic-type reaction whereby structures of the lens and ciliary body are displaced, which results in angle-closure glaucoma. Cataractous changes can result from antipsychotics, mainly from high dosages of chlorpromazine or thioridazine. These two drugs, when used at high dosages and for prolonged periods, frequently cause lenticular opacifications. Retinopathy has been shown to be related to high dosages of typical antipsychotics, mainly chlorpromazine and thioridazine. The frequency of occurrence of retinal effects seems to be proportional to the total amount of drug used over a long period of time. Other visual problems of special concern are the ocular dystonias, other eye movement disorders, and decreased ability to perceive colours and to discriminate contrast. Ocular dystonias can occur with antipsychotics (especially high-potency ones), carbamazepine (especially in polytherapy), topiramate and, rarely, with SSRIs. Disturbance in various eye movements is frequently seen with benzodiazepines, antiepileptic drugs and lithium. Impairment in the perception of colours and the discrimination of contrasts has been shown to occur not uncommonly with carbamazepine and lorazepam. Thus, typical antipsycho...

show abstract

Section: Abnormal Colour Perceptionmentioning

confidence: 99%

Ocular Adverse Effects of Common Psychotropic Agents

Richa¹,

Yazbek²

2010

CNS Drugs

178

143

View full text Add to dashboard Cite

show abstract

“…Furthermore, other drugs (barbiturates, benzodiazepines, and tiagabine) with a GABA-ergic component in their MOA do not affect retinal function in humans 16–18. Cerebral GABA levels were elevated in healthy adults treated with topiramate, lamotrigine, or gabapentin; however, no correlation with VFDs was observed 5…”

Section: Resultsmentioning

confidence: 99%

“…The majority of TEAEs reported in topiramate-treated patients were VFDs (all indications: 0.1%–0.4%), scotoma (migraine prophylaxis and monotherapy epilepsy: <0.1% to 0.4%), and optic atrophy (adjunctive epilepsy: 0.2%). Optic atrophy TEAEs were all reported for patients receiving adjunctive topiramate treatment for epilepsy, who were also concomitantly receiving valproate, another AED that has been associated with VFDs 18,20,21. Most of the TEAEs were mild or moder ate in severity; the majority resolved.…”

Section: Resultsmentioning

confidence: 99%

Comprehensive review of visual defects reported with topiramate

Ford

Goldberg

Selan

et al. 2017

OPTH

View full text Add to dashboard Cite

ObjectiveThe objective of this study was to analyze clinical patterns of visual field defects (VFDs) reported with topiramate treatment and assess possible mechanism of action (MOA) for antiepileptic drug (AED) associated VFDs.MethodsA comprehensive topiramate database review included preclinical data, sponsor’s clinical trials database, postmarketing spontaneous reports, and medical literature. All treatment-emergent adverse events (TEAEs) suggestive of retinal dysfunction/damage were summarized. Relative risk (RR) was computed from topiramate double-blind, placebo-controlled trials (DBPCTs) data.ResultsPreclinical studies and medical literature review suggested that despite sharing gamma-aminobutyric acid (GABA)-ergic MOA with other AEDs, topiramate treatment was not associated with VFDs. TEAEs suggestive of retinal dysfunction/damage were observed in 0.3%–0.7% of adults and pediatric patients with topiramate (N=4,679) versus ≤0.1% with placebo (N=1,834) in DBPCTs for approved indications (epilepsy and migraine prophylaxis); open-label trials (OLTs) and DBPCTs for investigational indications had similar incidence. Overall, 88% TEAEs were mild or moderate in severity. Serious TEAEs were very rare (DBPCTs: 0%; OLTs: ≤0.1%), and most were not treatment limiting, and resolved. The most common visual TEAEs (approved indications) were VFD, scotoma, and optic atrophy. The incidence of TEAEs in DBPCTs (approved and investigational indications) was higher in topiramate-treated (N=9,169) versus placebo-treated patients (N=5,023; 0.36% vs 0.24%), but the RR versus placebo-treated patients was not significant (RR: 1.51 [95% confidence interval: 0.78, 2.91]).ConclusionVFDs do not appear to be a class effect for AEDs with GABA-ergic MOA. The RR for VFDs is not significantly different between topiramate and placebo treatment.

show abstract

“…32,33 SWAP abnormalities have been identified in people with migraine, 34 those being treated with valproate and carbamazepine for epilepsy 35 and women being treated with tamoxifen. 36 While SWAP detects deficits earlier than white-on-white perimetry, it exhibits higher individual test-retest variability than standard automated perimetry (SAP).…”

Section: Short Wavelength Automated Perimetrymentioning

confidence: 99%

Recent developments in perimetry: test stimuli and procedures

McKendrick

2005

Clinical and Experimental Optometry

View full text Add to dashboard Cite

Automated perimetry has evolved substantially in recent years, in part due to modern computer technology that enables more complex visual stimuli and test procedures to be realised than those incorporated in traditional white-on-white luminance increment perimetry. This paper reviews briefly a number of advances in automated perimetry. The review includes discussion of new test types: frequency doubling technology perimetry, short wavelength automated perimetry, flicker perimetry, high-pass resolution perimetry and rarebit perimetry. Test algorithms applied to perimetry such as zippy estimation of sequential thresholds (ZEST), Swedish interactive thresholding algorithm (SITA), tendency-oriented perimetry (TOP) and multi-sampling supra-threshold perimetry are also discussed.

show abstract

Color vision in epileptic adolescents treated with valproate and carbamazepine

Abstract: Our study demonstrates that treatment with VPA or CBZ can affect significantly both central and paracentral color vision after a short treatment period.

Cited by 27 publications

References 22 publications

Ocular Adverse Effects of Common Psychotropic Agents

Ocular Adverse Effects of Common Psychotropic Agents

Comprehensive review of visual defects reported with topiramate

Recent developments in perimetry: test stimuli and procedures

Contact Info

Product

Resources

About