The purpose of this study was to assess the role of 30Hz flicker electroretinogram (ERG) as a marker for measuring changes in visual function over time in children receiving vigabatrin. This was an observational study of 11 children with mean age 7.14 ±2.9 months. There was a significant change in amplitude after starting vigabatrin at six- and 12-months follow-up; mean difference of 3.21 ±2.45uV at six months and 5.72 ±4.18uV at 12 months. Eight children showed vigabatrin-induced retinal toxicity. The dose was reduced from 500 to 250mg/day for two children showing toxicity at six months. Electroretinogram amplitude showed reduced amplitude at 12 months and did not return to baseline. Vigabatrin was stopped for one other child who also showed the same reduced amplitude. The authors conclude vigabatrin can cause irreversible visual function loss, which is mostly asymptomatic because the macula is usually spared. They propose 30Hz flicker ERG can be used as a screening tool to monitor and record early retinal changes due to vigabatrin. Retinal toxicity appears related to duration of treatment and not dose. Therefore, it is recommended to minimise vigabatrin treatment to a six-month period.
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Vigabatrin-induced retinal toxicity detected by 30Hz ERG
Reviewed by Fiona Rowe
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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