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From Service d’Explorations Fonctionnelles de la Vision (Drs. Arndt, Defoort-Dhellemmes, and Hache) and Service de Neurophysiologie Clinique (Dr. Derambure), Lille, France.
Address correspondence and reprint requests to Dr. Carl Arndt, Exploration Fonctionnelles de la Vision, Hôpital Roger Salengro, F-59037 Lille Cedex, France; e-mail: carndt{at}univ-lille2.fr
OBJECTIVE: To assess early visual impairment related to vigabatrin prospectively in patients with and without visual symptoms.
BACKGROUND: Vigabatrin acts as an inhibitor of gamma-aminobutyric acid (GABA) transaminase. GABA-induced ion transport changes in the retinal pigment epithelium have been described. The electro-oculogram (EOG) is a clinical test that reflects photoreceptor and pigment epithelium function. Patients and methods:— Of the 22 consecutive patients presenting with a history of partial seizures currently treated with vigabatrin, 20 were included in the study. A complete clinical ophthalmologic and neurologic examination was performed, including static 100-point perimetry, EOG, and electroretinogram (ERG).
RESULTS: In 14 of 20 patients, the light/dark ratio (Arden ratio) of the standard EOG was reduced in at least one eye. The a- and b-wave amplitudes and implicit time of the ERG were within the normal range in all patients; however, ERG oscillatory potentials could not be recorded in 10 patients. Twelve patients had visual field constriction; five complained of visual symptoms. The most severe visual impairment was observed in patients treated with both vigabatrin and valproate.
CONCLUSIONS: There is some evidence of outer retinal dysfunction in the patients treated with vigabatrin. EOG, a more sensitive diagnostic tool than ERG for screening vigabatrin-treated patients, also appears to be more specific.
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