title: Visual field constriction in children with epilepsy on vigabatrin treatment.
abstract: Vigabatrin is considered the drug of choice for infantile spasms and simple and complex partial epilepsy in childhood. Its mechanism of action relies on the irreversible inhibition of gamma-aminobutyric acid (GABA) transaminase. Since June 1997 several articles have been published reporting visual field constriction in adult patients on vigabatrin therapy. Recently, 7 pediatric patients, 1 on vigabatrin monotherapy and 6 on add-on therapy with visual field constriction have been described. We have observed 30 pediatric patients with epilepsy (14 boys and 16 girls), ages ranging from 4 to 20 years (mean: 11 years and 2 months) treated with vigabatrin for infantile spasms, simple and complex partial epilepsy, who had never complained of ophthalmologic disturbances. Twenty-one patients underwent complete routine ophthalmologic examination (fundus oculi, visual acuity, intraocular pressure, and visual field tests); 9 children (<6 years old) underwent only fundus examination, because collaboration was lacking. We report on 4 children showing constriction of visual field, prevailing in nasal hemifield. In 1 child, visual abnormalities were stable even 10 months after vigabatrin discontinuation, while in another a greater improvement was observed 5 months after discontinuation. The possible mechanisms have been discussed and the cone dysfunction, connected with GABA augmentation in the outer retina, has been outlined. We suggest a possible protocol to control visual abnormalities in epileptic children.
authors.affiliation: Pediatric Neurology, Department of Pediatrics, La Sapienza University 00161¿Rome, Italy. iannetti@iol.it
authors.forename: P
authors.initials: P
authors.lastname: Iannetti
authors.forename: A
authors.initials: A
authors.lastname: Spalice
authors.forename: F M
authors.initials: FM
authors.lastname: Perla
authors.forename: E
authors.initials: E
authors.lastname: Conicella
authors.forename: U
authors.initials: U
authors.lastname: Raucci
authors.forename: B
authors.initials: B
authors.lastname: Bizzarri
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D017029:Epilepsy, Complex Partial / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D020888:Vigabatrin / Q000009:adverse effects* / Q000627:therapeutic use; D014794:Visual Fields / Q000187:drug effects*
chemical_list: D000927:Anticonvulsants; D020888:Vigabatrin