Detecting Retinal Vigabatrin Toxicity in Patients with Partial Symptomatic or Cryptogenic Epilepsy

Akçakaya, Aylin Ardagil; Gokceer, Sevda; Erbil, Hasan Hasbi; Işık, Nihal; Özdöker, Levent; Salar, Senem; Aykan, Fatma; Aydin, Tuğrul; Yaylalı, Sevil Ari; Kesim, Ozlem

doi:10.1177/112067211002000419

Cited by 21 publications

(8 citation statements)

References 21 publications

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“…This was recognized by nasal quadrant attenuation and normal temporal thickness with or without inferior and superior changes. The finding of normal thickness of the temporal quadrant in all patients agrees with the results of our study as well as others (Durnian & Clearkin 2008; Akcakaya et al. 2010; Moseng et al.…”

Section: Discussionsupporting

confidence: 94%

Attenuation of the retinal nerve fibre layer and reduced retinal function assessed by optical coherence tomography and full‐field electroretinography in patients exposed to vigabatrin medication

Kjellström

Andréasson

Ponjavic

2013

Acta Ophthalmologica

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ABSTRACT.Purpose: To investigate the clinical value of assessment of peripapillary retinal nerve fibre layer (RNFL) thickness with OCT in addition to the evaluation of retinal function measured by full-field electroretinography (ff-ERG) in patients with suspected vigabatrin (VGB)-attributed visual field defects. Methods: Visual fields from adult patients in our clinical follow-up program for VGB medication were analysed. Twelve patients with suspected VGB-attributed visual field defects were selected for the study. They were re-examined with computerized kinetic perimetry, ff-ERG and OCT (2D circle scan). Results: Constricted visual fields were found in all patients. Comparative analysis of ff-ERG parameters showed reduced b-wave amplitudes for the isolated and the combined rod and cone responses (p < 0.0001). The a-wave, reflecting photoreceptor activity, was reduced (p = 0.001), as well as the summed amplitude of oscillatory potentials (p = 0.029), corresponding to inner retinal function. OCT measurements demonstrated attenuation of the RNFL in nine of 12 patients, most frequently superiorly and ⁄ or inferiorly. No temporal attenuation was found. Significant positive correlations were found between the total averaged RNFL thickness, superior and inferior RNFL thickness and reduced ff-ERG parameters. Positive correlations were also found between RNFL thickness and isopter areas. Conclusion: OCT measurements can detect attenuation of the RNFL in patients exposed to VGB medication. RNFL thickness correlates with reduced ff-ERG parameters and isopter areas of constricted visual fields, indicating that VGB is retino-toxic on several levels, from photoreceptors to ganglion cells. The study also supports previous studies, suggesting that OCT measurement of the RNFL thickness may be of clinical value in monitoring patients on vigabatrin therapy.

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Section: Discussionsupporting

confidence: 94%

Attenuation of the retinal nerve fibre layer and reduced retinal function assessed by optical coherence tomography and full‐field electroretinography in patients exposed to vigabatrin medication

Kjellström

Andréasson

Ponjavic

2013

Acta Ophthalmologica

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“…1). This technique has also been used in TSC to evaluate the optic nerve thickness of patients treated with vigabatrin, an antiepileptic drug known to cause a GABAergic retinopathy and visual field defect [14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Reduction in retinal nerve fiber layer thickness in tuberous sclerosis complex

et al. 2015

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Since a reduced RNFL thickness might be seen as an indicator of chronic axonal degeneration or lack of appropriate neuronal development, our results support the presence of axonal alterations in TSC and also that white matter disorganization could be much more diffuse than originally thought. Since axonal alterations directly derive from mammalian target of rapamycin (mTOR) overactivation, which occurs early during fetus development, the RNFL thinning we observed could represent one of the facets of such early neurodevelopmental abnormalities.

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“…Studies have shown that in vigabatrin toxicity, peripapillary RNFL thinning occurs first in the nasal quadrant with sparing of the temporal retina with or without involvement of the superior and inferior retina. 126–128 Peripapillary nasal RNFL thinning can be one of the earliest signs of toxicity even before VF loss and has been seen in patients receiving cumulative doses of 1000 g or less in the presence of normal VFs. 129 The time to occurrence of an attenuated RNFL thickness resulting from vigabatrin therapy is unknown, neither is the extent of any further attenuation over time.…”

Section: Review Of Diseasesmentioning

confidence: 99%

The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review

Mukherjee

Al-Fahad²,

Elsherbiny³

2019

Ophthalmol Eye Dis

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Optical coherence tomography is designed to evaluate in vivo qualitative and quantitative changes of the anterior segment, optic nerve and the retina. Initial applications of this technology were confined mainly to ophthalmic diseases. However recently, numerous studies have evaluated its use in systemic conditions and in therapeutics where, optic nerve and retinal architecture can be assessed to monitor progression of systemic conditions and its response to treatment. This is a narrative review aimed at evaluating the debate surrounding the role of spectral domain optical coherence tomography, in systemic conditions where optic nerve affection can be measured and be used in the diagnosis, monitoring and assessment of treatment effect as a non-invasive, quick, novel technique.

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Detecting Retinal Vigabatrin Toxicity in Patients with Partial Symptomatic or Cryptogenic Epilepsy

Abstract: RNFLT measurement with OCT can efficiently identify vigabatrin toxicity in patients with partial symptomatic and cryptogenic epilepsy. Perimetry, contrast sensitivity, and color discrimination assessment might be inconclusive in these particular subgroups of epileptic patients.

Cited by 21 publications

References 21 publications

Attenuation of the retinal nerve fibre layer and reduced retinal function assessed by optical coherence tomography and full‐field electroretinography in patients exposed to vigabatrin medication

Attenuation of the retinal nerve fibre layer and reduced retinal function assessed by optical coherence tomography and full‐field electroretinography in patients exposed to vigabatrin medication

Reduction in retinal nerve fiber layer thickness in tuberous sclerosis complex

The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review

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