Gfa. Harding et al., Separating the retinal electrophysiologic effects of vigabatrin - Treatment versus field loss, NEUROLOGY, 55(3), 2000, pp. 347-352
Objective: To separate the retinal electrophysiologic markers associated wi
th vigabatrin-attributed visual field loss (VGB-VFL) from those associated
with current vigabatrin therapy. Methods: A nonrandomly selected cohort of
8 previous and 18 current vigabatrin users and a reference cohort of 8 neve
r vigabatrin-treated patients with epilepsy receiving other antiepilepsy dr
ugs (AED) underwent electro-oculography (EOG), electroretinography (ERG), a
nd automated static threshold perimetry. A cohort of 22 normal subjects und
erwent ERG. The validity of the retinal electrophysiologic variables to det
ect the presence and severity of VGB-VFL was assessed using receiver operat
or characteristic curves. Results: Of 26 patients exposed to vigabatrin, 18
exhibited VGB-VFL. No patients receiving alternative AED showed this type
of visual field abnormality. The presence and severity of VGB-VFL was signi
ficantly associated with the latency (implicit time) and amplitude of the E
RG cone function. The amplitude of the cone flicker response was the strong
est predictor of VGB-VFL and revealed a sensitivity of 100% at a specificit
y of 75%. The EGG, the photopic and scotopic ERG, and the latency of the ER
G: second oscillatory potential (OP2) were not significantly related to the
presence of VGB-VFL. Vigabatrin therapy was significantly associated with
the photopic amplitude, the scotopic a-wave latency, and the latency of OP2
. Conclusion: In patients who cannot perform reliable perimetry, the cone-s
pecific ERG flicker amplitude provides the best screening method for detect
ing VGB-VFL.