Visual impairment in children with epilepsy treated with vigabatrin

Gross‐Tsur, Varda; Banin, Eyal; Shahar, Eli; Shalev, Ruth S.; Lahat, Eli

doi:10.1002/1531-8249(200007)48:1<60::aid-ana9>3.0.co;2-e

Cited by 78 publications

(40 citation statements)

References 21 publications

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“…44,45 This side effect also has been recently reported in children. 46,47 In one study, 6 of 12 children receiving vigabatrin had visual field defects. Visual field assessment could not be performed in 141 additional children because of age or developmental delay.…”

Section: Vigabatrin Is Vigabatrin Effective In the Treatment Trials mentioning

confidence: 99%

Practice Parameter: Medical Treatment of Infantile Spasms

Weiss²,

et al. 2004

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Abstract-Objective:To determine the current best practice for treatment of infantile spasms in children. Methods: Database searches of MEDLINE from 1966 and EMBASE from 1980 and searches of reference lists of retrieved articles were performed. Inclusion criteria were the documented presence of infantile spasms and hypsarrhythmia. Outcome measures included complete cessation of spasms, resolution of hypsarrhythmia, relapse rate, developmental outcome, and presence or absence of epilepsy or an epileptiform EEG. One hundred fifty-nine articles were selected for detailed review. Recommendations were based on a four-tiered classification scheme. Results: Adrenocorticotropic hormone (ACTH) is probably effective for the short-term treatment of infantile spasms, but there is insufficient evidence to recommend the optimum dosage and duration of treatment. There is insufficient evidence to determine whether oral corticosteroids are effective. Vigabatrin is possibly effective for the short-term treatment of infantile spasm and is possibly also effective for children with tuberous sclerosis. Concerns about retinal toxicity suggest that serial ophthalmologic screening is required in patients on vigabatrin; however, the data are insufficient to make recommendations regarding the frequency or type of screening. There is insufficient evidence to recommend any other treatment of infantile spasms. There is insufficient evidence to conclude that successful treatment of infantile spasms improves the long-term prognosis. Conclusions: ACTH is probably an effective agent in the short-term treatment of infantile spasms. Vigabatrin is possibly effective. NEUROLOGY 2004;62:1668 -1681 West syndrome 1 is a unique, age-specific epilepsy of early infancy. Infantile spasms are distinct from myoclonic and tonic seizures.2 They are characterized by an initial contraction phase followed by a more sustained tonic phase. They can be divided into three types (flexor, extensor, and mixed flexor-extensor spasms), and they can also be asymmetrical.2 The EEG characteristically demonstrates hypsarrhythmia, and onset of spasms is frequently associated with neurodevelopmental regression. The incidence of infantile spasms is

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Section: Vigabatrin Is Vigabatrin Effective In the Treatment Trials mentioning

confidence: 99%

Practice Parameter: Medical Treatment of Infantile Spasms

Weiss²,

et al. 2004

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“…The nasal field is typically, though not always, 54 -56 more extensively affected than the temporal field. [57][58][59][60] Unique alterations of specific electroretinographic parameters have been shown to correspond to this field defect.…”

Section: Vigabatrin Vfd: What It Ismentioning

confidence: 99%

“…The reported prevalence in children has varied from 20% 91,96 to 65%. 59 Numerous investigators have reported the prevalence in children to be well below that of adults, 91,96,98,99 suggesting a prevalence of approximately 20% in this younger population. The best data on infants 65,71,73,100 have established a prevalence of approximately 40%, with incidence of 16% as assessed by the highly sensitive electroretinogram (ERG) 30-Hz flicker amplitude.…”

Section: Prevalence Onset and Progression Of Vfd With Vigabatrinmentioning

confidence: 99%

Vigabatrin

2007

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Summary: Refractory epilepsies such as infantile spasms (IS) and complex partial seizures (CPS) can have a severe negative impact on the neurological integrity and quality of life of affected patients, in addition to drastically increasing their risk of premature mortality. Early identification of potentially effective pharmacotherapy agents is important. Vigabatrin has been shown to be a generally well tolerated and effective antiepileptic drug (AED) in a wide variety of seizure types affecting both children and adults, particularly those with IS and CPS. A bilateral, concentric constriction of the peripheral visual field characterizes the visual field defect (VFD) associated with vigabatrin, well characterized by numerous studies. This peripheral VFD presents in 30 -50% of patients with exposure of several years; however, most of these patients are asymptomatic. In well-controlled studies, the earliest onset in patients with CPS is 11 months and at 5 months in infants, with average onsets being more than 5 years and 1 year, respectively. Patients with a peripheral VFD retain an average 65°of lateral vision (normal, 90°). The fact that many patients never develop the vigabatrin-related peripheral VFD, despite long-term exposure at high doses, may support the hypothesis that the injury is an idiosyncratic adverse drug reaction (as opposed to a strict dose-or duration-dependent toxicity). Effective testing methods are available to aid in the early detection and management of the peripheral VFD. This article discusses issues of importance to clinical decision-making in the use of vigabatrin to assist the physician and patient in assessing the benefits of vigabatrin therapy and understanding the potential risks of the VFD and uncontrolled seizures.

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“…It occurs in around one-third of patients and is not usually reversible [6]. Vigabatrin was initially marketed for an add on treatment for focal epilepsy, but now its use has been limited to special situation [7].…”

Section: Vigabatrinmentioning

confidence: 99%

Untitled

2017

Cent Asian J Med Sci

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Objectives: Up to one third of epilepsy patients have an unsatisfactory treatment with antiepileptic drugs (AEDs), but advance in neuroimaging, neurophysiologic investigation and treatment modalities have substantially improved the approaches and understanding of intractable childhood epilepsy. Methods: Journal papers, reports, books and government publications on epilepsy treatment were collected and reviewed in chronological order. Results:There are approximately more than 15 newer AEDs developed since 1990, highlighted by the novel mechanism of action with minimal adverse effect, thus they have been frequently used for those who are unresponsive to conventional AEDs. Non-pharmacologic therapies including diet therapy, epilepsy surgery, and neuromodulatory treatment are also effective and should be considered early in the disease course. Diet therapy began to reemerge in mid 1990s, and studies with large data collection allowed to overcome major concerns; its side effects, difficult compliance and doubts on efficacy. And more liberal forms of the diet therapy were introduced to benefit adults and patients in developing counties, where strict supervision is unavailable. The surgical treatment has become increasingly more valuable and it is now accepted for the management of drug resistant focal epilepsy due to major advances in presurgical investigation methods, and surgical techniques. Conclusions: The timely assessment of children with drugresistant epilepsy and active application of advanced treatment modalities were necessary to prevent the effect of uncontrolled seizures on cognitive and behavioral development.

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Visual impairment in children with epilepsy treated with vigabatrin

Cited by 78 publications

References 21 publications

Practice Parameter: Medical Treatment of Infantile Spasms

Practice Parameter: Medical Treatment of Infantile Spasms

Vigabatrin

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