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The legacy of vigabatrin in a regional epilepsy clinic

The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK

Correspondence to:
Correspondence to:
Dr A Nicolson, The University Department of Neurosciences, Clinical Sciences Centre for Research and Education, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK;
andrew{at}nicolson71.freeserve.co.uk

Methods: Retrospective review of 583 patients prescribed vigabatrin at any time between 1989 and 2001 from a regional and satellite epilepsy clinic. Data were collected on dose and duration of treatment, results of quantitative perimetry, and reasons for, and outcome of, discontinuation.

Results: The visual fields were abnormal with no alternative cause in 42 of the 98 tested (43%). There was no clear relation between the cumulative dose of vigabatrin received and the occurrence of a visual field abnormality. Fifty patients continued taking vigabatrin, and a further 84 were lost to follow up while taking vigabatrin. In 75 patients who had stopped vigabatrin due to a visual field abnormality or concern over this potential adverse effect, the seizure control was no different or had improved in 66 (88%), while it had deteriorated in only 7 (9%).

Conclusions: This study confirms the previously reported high incidence of asymptomatic visual field defects associated with vigabatrin. Many patients taking vigabatrin may not have been counselled about the risks, and there are significant cost implications in tracing and assessing those patients lost to follow up. Switching over to another antiepileptic drug usually does not result in deterioration in seizure control, but in clinical practice an individual risk to benefit ratio needs to be taken into consideration.

Keywords: epilepsy; vigabatrin; visual field defects

Abbreviations: AED, antiepileptic drug; VFD, visual field defect

This article has been cited by other articles:

				J. M. Wild, C. R. Robson, A. L. Jones, I. A. Cunliffe, and P. E. M. Smith Detecting vigabatrin toxicity by imaging of the retinal nerve fiber layer. Invest. Ophthalmol. Vis. Sci., March 1, 2006; 47(3): 917 - 924. [Abstract] [Full Text] [PDF]