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Aydin H, Bucak IH, Altunisik E. Does levetiracetam use affect visual evoked potentials in the treatment of childhood epilepsy? Minerva Pediatr (Torino) 2024; 76:86-92. [PMID: 33820402 DOI: 10.23736/s2724-5276.21.05879-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Side effects of antiepileptic drugs vary depending on the drug itself, drug dose and duration of use. One of these side effects is related to vision. METHODS Patients who had been ordered visual evoked potential (VEP) measurements for various reasons between October 1st, 2017 and October 1st, 2019 at a pediatric neurology outpatient clinic and who were on levetiracetam monotherapy for at least six months for the treatment of focal/generalized epilepsy were included in the study and their files were scanned retrospectively (study group: SG). Patient files were evaluated for age, gender, dose and duration of levetiracetam use, presence of a family history of epilepsy, EEG result, cranial magnetic resonance imaging and VEP test results and the parameters were recorded. Twenty-four patients of similar age range without epilepsy were included in the study as the control group (CG). RESULTS Eighteen patients 8 boys (44.4%), 10 girls (55.6%) and 24 healthy controls 9 boys (37.5%), 15 girls (62.5%) were included in the study and control groups, respectively. No statistically significant difference was found when the mean VEP latencies were compared between the patient and control groups for the right (P=0.451) and left (P=0.323) eyes. There was a statistically significant difference between the groups, respectively, when VEP amplitudes of the right and left eyes of the SG and CG were compared (P=0.001; P=0.001). There is no correlation between levetiracetam dose and duration of treatment and VEP parameters. CONCLUSIONS The data obtained in this study showed that levetiracetam use affected VEP amplitude outcome but did not affect VEP latency outcome in pediatric patients.
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Affiliation(s)
- Hilal Aydin
- Department of Pediatric Neurology, Faculty of Medicine, Balikesir University, Balikesir, Türkiye -
| | - Ibrahim H Bucak
- Department of Pediatrics, Faculty of Medicine, Adiyaman University, Adiyaman, Türkiye
| | - Erman Altunisik
- Department of Neurology, Faculty of Medicine, Adiyaman University, Adiyaman, Türkiye
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Manthos K, Theotokis P, Dermitzakis I, Avramidou E, Meditskou S, Manthou ME, Emmanouil‐Nikoloussi E. Valproic acid induced selective apoptosis of ocular fibrous tunic in mice fetuses. Birth Defects Res 2022; 114:1257-1265. [DOI: 10.1002/bdr2.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Kyriakos Manthos
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Paschalis Theotokis
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Laboratory of Experimental Neurology and Neuroimmunology, Second Department of Neurology AHEPA University Hospital Thessaloniki Greece
| | - Iasonas Dermitzakis
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Eleni Avramidou
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Soultana Meditskou
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Maria Eleni Manthou
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Elpida‐Niki Emmanouil‐Nikoloussi
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Department of Histology‐Embryology, Department of Dentistry, School of Medicine European University of Cyprus Nicosia Cyprus
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Gekova MV. FEATURES OF USING THE EVOQUED POTENTIAL METHOD IN CHILDREN WITH EPILEPSY. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2022. [DOI: 10.29254/2077-4214-2022-4-167-23-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- M. V. Gekova
- State Institution "Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine"
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Kaplan AT, Oskan Yalcın S, Sager SG. Evaluation of optical coherence tomography findings in adolescents with genetic generalized epilepsy. Eur J Ophthalmol 2021; 32:3650-3656. [PMID: 34657446 DOI: 10.1177/11206721211049710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and subfoveal choroid thickness (CT) by using optical coherence tomography (OCT) in adolescents with newly diagnosed epilepsy and patients who had been using Na valproate (VPA) for at least 1 year. METHODS We examined 60 patients with genetic generalized epilepsy (GGE) aged 8-17 years. Thirty patients with newly diagnosed GGE who were evaluated before the beginning of the therapy and another 30 patients who were chosen from among adolescents with epilepsy using VPA for at least 1 year were included in the study. RESULTS Nasal quadrant RNFL thickness and CMT measurements were significantly lower in the monotherapy group compared with the newly diagnosed group (p = 0.044 and p = 0.032, respectively). CT measurements were not significantly different between the groups (p = 0.413). There was a negative correlation in regression analysis between the duration of drug use and RNFL thickness in all quadrants. CONCLUSION According to our study, we observed thinning of the nasal RNFL and macular thickness in adolescents with epilepsy who were using Na valproate for at least 1 year and that as the duration of use increased, the thinning occurred in all RNFL quadrants. Further studies with larger series are needed to better understand the effects of both epilepsy and VPA on the eye.
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Affiliation(s)
- Aysin Tuba Kaplan
- Ophthalmology Department, 147015Kartal Dr Lutfi Kırdar State Hospital, Kartal, Istanbul, Turkey
| | - Sibel Oskan Yalcın
- Ophthalmology Department, 147015Kartal Dr Lutfi Kırdar State Hospital, Kartal, Istanbul, Turkey
| | - Safiye Gunes Sager
- Pediatric Neurology Department, 147015Kartal Dr Lutfi Kirdar State Hospital, Kartal, Istanbul, Turkey
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Abstract
PURPOSE OF REVIEW Cortical visual impairment (CVI) is the leading cause of pediatric visual impairment in developed countries. Currently, there is no standardized method of visual assessment in these children, who usually cannot participate in tests designed for typically developing children. A reproducible method of visual assessment that accurately reflects the multitude of visual deficits in CVI is critical to evaluate proposed therapies for this disorder. This review analyzes current research on methods of visual assessment in children with CVI. RECENT FINDINGS Earlier studies focused on measuring visual acuity in children with CVI. More recent studies have emphasized other aspects of visual function, such as contrast sensitivity, motion detection, and visual search. Current research topics include questionnaires, functional vision assessment (CVI Range), neuropsychological tests of visual perception, and eye tracking. Eye tracking shows promise for visual assessment in both clinical and research settings because it is objective and quantitative, with the ability to assess diverse visual parameters. SUMMARY Current research on visual assessment in children with CVI focuses on measuring deficits of visual function beyond visual acuity. This research represents an important step toward designing clinical trials to identify effective therapeutics for this increasingly prevalent disorder with heterogeneous manifestations.
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Abstract
There is increasing recognition that epilepsy can be associated with a broad spectrum of comorbidities. While epileptic seizures are an essential element of epilepsy in children, there is a spectrum of neurological, mental health and cognitive disorders that add to the disease burden of childhood epilepsy resulting in a decreased quality of life. The most common comorbid conditions in childhood epilepsy include depression, anxiety, autism spectrum disorders, sleep disorders, attention deficits, cognitive impairment, and migraine. While epilepsy can result in comorbidities, many of the comorbidities of childhood have a bi-directional association, with the comorbid condition increasing risk for epilepsy and epilepsy increasing the risk for the comorbid condition. The bidirectional feature of epilepsy and the comorbidities suggest a common underlying pathological basis for both the seizures and comorbid condition. While recognition of the comorbid conditions of pediatric epilepsies is increasing, there has been a lag in the development of effective therapies partly out of concern that drugs used to treat the comorbid conditions could increase seizure susceptibility. There is now some evidence that most drugs used for comorbid conditions are safe and do not lower seizure threshold. Unfortunately, the evidence showing drugs are effective in treating many of the childhood comorbidities of epilepsy is quite limited. There is a great need for randomized, placebo-controlled drug trials for efficacy and safety in the treatment of comorbidities of childhood epilepsy.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Stafford Hall, 118C, Burlington, VT, 05405, USA.
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Hazirolan D, Duman M, Guler SK, Uney G, Ornek F. Retinal ganglion cell complex and visual evoked potentials in levetiracetam treatment. Cutan Ocul Toxicol 2020; 39:237-243. [PMID: 32543904 DOI: 10.1080/15569527.2020.1778016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine central macular, RNFL (retinal nerve fibre layer), GCC (ganglion cell complex) thicknesses; and VEPs (visual evoked potential) in epileptic patients using levetiracetam for at least one year. MATERIALS AND METHODS Sixteen focal epileptic patients receiving levetiracetam monotherapy and 16 healthy subjects were included in the study. Central macular, RNFL and GCC thicknesses according to spectral domain OCT (optical coherence tomography); and VEPs parameters were compared between patients and healthy subjects. RESULTS The mean age of patient and control groups were 40 ± 16 and 38 ± 12 years respectively (p > 0.05). The patient group was on levetiracetam therapy for 64 ± 45 (12-168) months. Central macular thickness was thinner in the patient group (p = 0.008). There was no difference among groups regarding RNFL thicknesses. GCC thicknesses in all quadrants were similar among groups, except the superior quadrant; which was thinner in the patient group (p = 0.03). P100 amplitude in 30 min pattern was lower in the patient group (p = 0.04). N135 latency in 15 min (p = 0.03) and 7 min patterns (p = 0.01) was longer in the patient group. CONCLUSION Central macular and GCC thicknesses; and VEP parameters in patients receiving levetiracetam treatment may differ from healthy subjects.
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Affiliation(s)
- Dicle Hazirolan
- Ankara Training and Research Hospital, Ophthalmology Department, University of Health Sciences, Ankara, Turkey
| | - Melih Duman
- Ankara City Hospital, Ophthalmology Department, University of Health Sciences, Ankara, Turkey
| | - Selda Keskin Guler
- Ankara Training and Research Hospital, Neurology Department, University of Health Sciences, Ankara, Turkey
| | - Guner Uney
- Ankara Training and Research Hospital, Ophthalmology Department, University of Health Sciences, Ankara, Turkey
| | - Firdevs Ornek
- Ankara Training and Research Hospital, Ophthalmology Department, University of Health Sciences, Ankara, Turkey
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Hamed SA, Oseily AM. Peripheral and central auditory function in adults with epilepsy and treated with carbamazepine. HEARING, BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1630975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sherifa A. Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Amira M. Oseily
- Department of ENT, Audiology Unit, Assiut University Hospital, Assiut, Egypt
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Effects of Sodium Valproate, Levetiracetam and Phenytoin Therapy on Evoked Potentials in Children with Epilepsy. Indian J Pediatr 2019; 86:860. [PMID: 30847865 DOI: 10.1007/s12098-019-02906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
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Xiong W, Lu L, Zhang Y, Xiao Y, Gao H, Zhang M, Zhou D. Attenuation of retinal nerve fibre layer in people with epilepsy receiving valproate. Epilepsy Res 2019; 154:144-148. [PMID: 31151074 DOI: 10.1016/j.eplepsyres.2019.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/07/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Valproate (VPA) is one of the most frequently used anti-epileptic drugs (AEDs) worldwide. Its effects in decreasing the retinal nerve fibre layer (RNFL) thickness remain debatable. We aimed to evaluate the effect of VPA usage on the RNFL in comparison with other AEDs and no AED usage in people with epilepsy (PWE). METHODS In this observational case-control study, PWE were enrolled and divided into three groups: PWE 1) receiving VPA monotherapy throughout their clinical course; 2) receiving an AED other than VPA as monotherapy; and 3) who never took any AED. RNFL thickness of the right eye was measured by optical coherence tomography (OCT). In each individual, disease-related information was recorded. RESULTS A total of 86 individuals (51 males; median age, 25 years) with an average epilepsy duration of 6.88 years were enrolled. No difference in the demographics except for sex was noted between the groups. The average RNFL thickness in 26 individuals who had received VPA (group I) was 93.73 ± 9.24 μm, which was significantly lower than the corresponding values for the 31 individuals who received other single AED regimens (group II; 99.71 ± 8.50 μm; p = 0.031) or the 29 individuals who never used any AED (group III; 102.79 ± 8.05 μm; p = 5.67 × 10-4), especially in the superior and inferior quadrants. The RNFL attenuation was significantly correlated with the epilepsy duration in groups II and III (r = 0.351, p = 0.006). However, no correlation between epilepsy duration, cumulative dosage of VPA, duration of treatment with VPA and RNFL thickness was found in group Ⅰ. CONCLUSION These preliminary findings suggest an association between VPA usage and reduction of retinal thickness in PWE, especially in the superior and inferior quadrants. Epilepsy itself might also be another risk factor for RNFL attenuation. Further studies need to confirm this finding and to unravel the underlying mechanism.
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Affiliation(s)
- Weixi Xiong
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Lu Lu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Yingfeng Xiao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Hui Gao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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Hamed SA. Ocular dysfunctions and toxicities induced by antiepileptic medications: Types, pathogenic mechanisms, and treatment strategies. Expert Rev Clin Pharmacol 2019; 12:309-328. [PMID: 30840840 DOI: 10.1080/17512433.2019.1591274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Ocular dysfunctions and toxicities induced by antiepileptic drugs (AEDs) are rarely reviewed and not frequently received attention by treating physicians compared to other adverse effects (e.g. endocrinologic, cognitive and metabolic). However, some are frequent and progressive even in therapeutic concentrations or result in permanent blindness. Although some adverse effects are non-specific, others are related to the specific pharmacodynamics of the drug. Areas covered: This review was written after detailed search in PubMed, EMBASE, ISI web, SciELO, Scopus, and Cochrane Central Register databases (from 1970 to 2019). It summarized the reported ophthalmologic adverse effects of the currently available AEDs; their risks and possible pathogenic mechanisms. They include ocular motility dysfunctions, retinopathy, maculopathy, glaucoma, myopia, optic neuropathy, and impaired retinal vascular autoregulation. In general, ophthalmo-neuro- or retino-toxic adverse effects of AEDs are classified as type A (dose-dependent), type B (host-dependent or idiosyncratic) or type C which is due to the cumulative effect from long-term use. Expert opinion: Ocular adverse effects of AEDs are rarely reviewed although some are frequent or may result in permanent blindness. Increasing knowledge of their incidence and improving understanding of their risks and pathogenic mechanisms are crucial for monitoring, prevention, and management of patients' at risk.
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Affiliation(s)
- Sherifa A Hamed
- a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt
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Abstract
OBJECTIVE This study aimed to evaluate vestibular function in adults with chronic epilepsy of unknown etiology in the inter-ictal period. BACKGROUND Epilepsy is a chronic medical disorder. Life-long therapy may be required in one-third of patients. Epilepsy is associated with comorbid somatic conditions which impairs patients' quality of life. METHODS This cross-sectional study included 28 with generalized tonic clonic (GTC) convulsions and 14 and 3 with temporal (TLE) and frontal lobe (FLE) epilepsies with secondary generalization (all were on regular carbamazepine therapy) and 40 healthy control subjects. The patients' mean age was 34.97 ± 7.35 years and the duration of illness was 18.75 ± 7.99 years. All underwent videonystagmography (VNG). RESULTS Compared with controls, patients had frequent vestibular symptoms including dizziness (62.22%) (p = 0.0001) and sense of imbalance (44.44%) (p = 0.0001). Eleven patients (24.44%) had central vestibular dysfunction (p = 0.0001); 9 (20%) had mixed vestibular dysfunction and one (2.22%) had peripheral vestibular dysfunction (p = 0.0001). Abnormalities were observed in saccadic (44.4%) and pursuit (42.2%) eye movements, optokinetic nystagmus (42.2%) and positioning/positional (11.11%) and caloric (13.33%) testing. TLE and FLE were associated with more VNG abnormalities than GTC. No significant differences were observed in the demographic and clinical characteristics between patients with and without VNG abnormalities. CONCLUSION Vestibular manifestations are frequent in patients with epilepsy. This may be a result of the permanent damaging effect of chronic epilepsy on the vestibular cortical areas and/or a toxic effect from prolonged carbamazepine therapy on the peripheral and central vestibular systems.
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Hamed SA. The auditory and vestibular toxicities induced by antiepileptic drugs. Expert Opin Drug Saf 2017; 16:1281-1294. [DOI: 10.1080/14740338.2017.1372420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Sherifa A Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
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Hébert-Lalonde N, Carmant L, Major P, Roy MS, Lassonde M, Saint-Amour D. Electrophysiological Evidences of Visual Field Alterations in Children Exposed to Vigabatrin Early in Life. Pediatr Neurol 2016; 59:47-53. [PMID: 27105764 DOI: 10.1016/j.pediatrneurol.2016.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND We assessed central and peripheral visual field processing in children with epilepsy who were exposed to vigabatrin during infancy. METHODS Steady-state visual evoked potentials and pattern electroretinograms to field-specific radial checkerboards flickering at two cycle frequencies (7.5 and 6 Hz for central and peripheral stimulations, respectively) were recorded from Oz and at the eye in seven school-age children (10.1 ± 3.5 years) exposed to vigabatrin early in life, compared with children early exposed to other antiepileptic drugs (n = 9) and healthy children (n = 8). The stimulation was made of two concentric circles (0 to 5 and 30 to 60 degrees of angle) and presented at four contrast levels (96%, 64%, 32%, and 16%). RESULTS Ocular responses were similar in all groups for central but not for the peripheral stimulations, which were significantly lower in the vigabatrin-exposed group at high contrast level. This peripheral retinal response was negatively correlated to vigabatrin exposure duration. Cortical responses to central stimulations, including contrast response functions in the children with epilepsy in both groups, were lower than those in normally developing children. CONCLUSIONS Alteration of ocular processing was found only in the vigabatrin-exposed children. Central cortical processing, however, was impaired in both epileptic groups, with more pronounced effects in vigabatrin-exposed children. Our study suggests that asymptomatic long-term visual toxicity may still be present at school age, even several years after discontinuation of drug therapy.
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Affiliation(s)
- Noémie Hébert-Lalonde
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada; Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Lionel Carmant
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Major
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | | | - Maryse Lassonde
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada; Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Dave Saint-Amour
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Ophtalmology, Université de Montréal, Montreal, Quebec, Canada; Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.
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The Effects of Levetiracetam, Carbamazepine, and Sodium Valproate on P100 and P300 in Epileptic Patients. Clin Neuropharmacol 2013; 36:55-8. [DOI: 10.1097/wnf.0b013e318285f3da] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Strigaro G, Prandi P, Varrasi C, Monaco F, Cantello R. Defective visual inhibition in photosensitive idiopathic generalized epilepsy. Epilepsia 2012; 53:695-704. [DOI: 10.1111/j.1528-1167.2012.03411.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Somatosensory evoked potentials in epileptic children treated with carbamazepine or valproate in monotherapy - a preliminary study. Adv Med Sci 2010; 55:212-5. [PMID: 20513644 DOI: 10.2478/v10039-010-0019-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Data from the literature suggest that long-term therapy with various antiepileptic drugs can be responsible for the functional disturbances within the nervous system e.g. peripheral neuropathy and encephalopathy. Useful and non-invasive instruments for evaluation of even subclinical nerve conduction abnormalities in somatosensory tracts are somatosensory evoked potentials (SEPs). The aim of this study was to assess the potentially drug-induced abnormalities in the SEP parameters in epileptic children, treated chronically in monotherapy with one of the two most often used antiepileptic drugs: valproate (VPA) or carbamazepine (CBZ). MATERIALS AND METHODS SEP from left median nerve stimulation were recorded in twenty children with idiopathic/cryptogenic epilepsy treated in monotherapy with CBZ (9 patients) or VPA (11 patients). The mean age of the patients was 13.4 ± 2.9 years (range 7-17 years). The plasma concentrations of the drugs were consistently within therapeutic range. The mean duration of treatment was eight months. The control group consisted of twenty-four age-matched children with tension type headache. The latencies of the components: N9, N13, N20, P25 and the peripheral conduction time (PCT) and central conduction time (CCT) were analyzed. RESULTS No significant differences in all analyzed SEP parameters between the epileptic and control children were found. CONCLUSIONS Our results indicate that during the first 8 months from the beginning of antiepileptic treatment in children, monotherapy with VPA or CBZ does not induce nerve conduction disturbances within both the peripheral- and the central part of the somatosensory tracts, detected in SEP examination.
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Wakamoto H, Nakamura Y, Ebihara T, Tokuda K, Ohmori H. Reversible coma associated with prolonged high-dose phenobarbital therapy in bilateral Sturge-Weber syndrome. J Child Neurol 2009; 24:1547-51. [PMID: 19671890 DOI: 10.1177/0883073808331360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High-dose phenobarbital therapy is an effective treatment for refractory status epilepticus in children. The advantages of this therapy include milder adverse effects without limits for maximal phenobarbital levels or doses during the initial phase of treatment. However, little is known about the safety of continuing the treatment. We describe an infant with intractable epilepsy associated with bilateral Sturge-Weber syndrome who became comatose after 1(2/3) months of high-dose phenobarbital treatment. The patient regained consciousness as serum phenobarbital concentration decreased to below 40 microg/mL. The progression and recovery were also documented by electroencephalogram and brainstem auditory evoked potentials. The present case suggests that prolonged high-dose phenobarbital therapy may cause cerebral and brainstem dysfunction in patients with severe cerebrovascular diseases. The underlying baseline metabolic and perfusion deficit related to the disease can precipitate the neurological complication during long-term high-dose phenobarbital therapy.
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Affiliation(s)
- Hiroyuki Wakamoto
- Department of Pediatrics, Ehime Prefecture Central Hospital, Matsuyama City, Ehime Prefecture, Japan.
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Nekrassov V, Sitges M. Comparison of acute, chronic and post-treatment effects of carbamazepine and vinpocetine on hearing loss and seizures induced by 4-aminopyridine. Clin Neurophysiol 2008; 119:2608-14. [PMID: 18829385 DOI: 10.1016/j.clinph.2008.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 08/17/2008] [Accepted: 08/20/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the acute, chronic and post-treatment effects of the classic antiepileptic drug carbamazepine (CBZ) and the potential antiepileptic vinpocetine (VPC), successfully used in the treatment of brain vascular origin disorders, on 4-aminopyridine (4-AP)-induced increase in auditory threshold, brain-auditory-evoked-potentials (BAEPs) later waves alterations and epileptiform activity. METHODS BAEP and EEG recordings before and following 4-AP (3mg/kg, i.p.) were obtained in guinea pigs. One week after, the animals received a daily injection (i.p.) of vehicle, 3mg/kg VPC or 17 mg/kg CBZ for 13 days. The acute and chronic effects before and following 4-AP were tested at the 1st and last days, respectively, and the post-treatment effect 1 month after the end of treatment. RESULTS CBZ and 4-AP increased BAEPs threshold and BAEPs P4 wave latency. Chronic CBZ inhibited 4-AP-induced increase in P3 amplitude. In the VPC-treated group, all the 4-AP-induced BAEPs changes were prevented. Seizures were prevented in 50% and 75% of the animals by chronic CBZ and VPC, respectively. After acute VPC and after the end of VPC-treatment 4-AP failed to induce seizures in 50% of the animals. CONCLUSION VPC inhibits 4-AP-induced seizures and hearing loss, even after post-treatment, at a concentration about 10 times lower than CBZ. SIGNIFICANCE The complications in hearing that can accompany epilepsy can be prevented by VPC, indicating its advantage as an alternative antiepileptic.
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Verrotti A, Manco R, Matricardi S, Franzoni E, Chiarelli F. Antiepileptic drugs and visual function. Pediatr Neurol 2007; 36:353-60. [PMID: 17560495 DOI: 10.1016/j.pediatrneurol.2007.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/20/2006] [Accepted: 03/22/2007] [Indexed: 01/23/2023]
Abstract
Antiepileptic drugs are known to result in visual disturbances. A number of antiepileptic drugs have recently been reported to result in various abnormalities of vision, particularly deficiencies in visual fields and color vision. Moreover, there has been a marked improvement in the diagnosis and understanding of the pathophysiology of visual disturbance. This review collects evidence for visual adverse effects induced by the older antiepileptic drugs (barbiturates, benzodiazepine, carbamazepine, valproic acid, ethosuximide, and phenytoin) and the newer ones (vigabatrin, topiramate, tiagabine, levetiracetam, lamotrigine, gabapentin, felbamate, and oxcarbazepine).
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Sitges M, Nekrassov V. Acute and chronic effects of carbamazepine, phenytoin, valproate and vinpocetine on BAEP parameters and threshold in the guinea pig. Clin Neurophysiol 2007; 118:420-6. [PMID: 17157555 DOI: 10.1016/j.clinph.2006.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 10/02/2006] [Accepted: 10/16/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the acute and chronic effects of the antiepileptic drugs (AEDs): carbamazepine (CBZ), phenytoin (PHT), valproic acid (VPA) and vinpocetine (VPC), at doses 20, 6, 30 and 2mg/kg, respectively, on the latencies and amplitudes of the waves of brainstem auditory evoked potentials (BAEPs) elicited by a supra-threshold stimulus alongside BAEP threshold. METHODS BAEPs elicited by a stimulus of high (100dB nHL) intensity and BAEP thresholds were obtained at 4 and 8kHz: before, after the start of treatment, and following 28 days of a daily injection of the AEDs. RESULTS After the start of treatment BAEPs were unchanged. After the long term treatment, CBZ and PHT increased P3 and P4 wave peak latencies and reduced P4 amplitude. Chronic VPA did not modify BAEP waves, and chronic VPC reduced P3 and P4 latencies. P1 and P2 were unchanged. BAEP thresholds at 4 and 8kHz were increased by CBZ, PHT and VPA, and decreased by VPC. CONCLUSIONS The chronic administration of several AEDs modifies BAEP waves of retro-cochlear origin. SIGNIFICANCE Alterations in the generators of the later waves of BAEPs underlie, in most cases, the changes in hearing sensitivity produced by the long term treatment with AEDs at therapeutic relevant doses.
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Affiliation(s)
- María Sitges
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico.
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Maertz NA, Kim CBY, Nork TM, Levin LA, Lucarelli MJ, Kaufman PL, Ver Hoeve JN. Multifocal visual evoked potentials in the anesthetized non-human primate. Curr Eye Res 2006; 31:885-93. [PMID: 17050280 DOI: 10.1080/02713680600899648] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate monkey multifocal visual evoked cortical potentials (mfVEPs) recorded from central and peripheral fields for reliability and isolation from electroretinographic (ERG) activity. METHODS The mfVEP stimulus consisted of a 7-element hexagonal array that subtended 80 degrees of the central visual field. Recordings were made under intravenous pentobarbital sodium (15 mg/kg) anesthesia. Two monkeys with absent optic nerve and ganglion cell function after combined unilateral optic nerve transection and experimental ocular hypertension (ONT/OHT) were followed longitudinally. In a second study, 16 ophthalmologically normal monkeys were tested once. RESULTS Testing of the non-transected eye in two transected animals revealed robust first- and second-order kernel, first slice (K1 and K2.1) mfVEPs. Stimulation of the transected eye revealed no contamination of the mfVEP from the concurrently recorded multifocal ERGs. There was complete separation of the root-mean-square (RMS) mfVEP amplitudes from the transected and the fellow eyes tested repeatedly across a 4- to 17- month period. The largest amplitude mfVEP was generated by the central element; however, mfVEPs were recorded from outside the central 20 degrees element. The 16 normal animals showed waveforms similar to the normal eyes of the ONT/OHT animals both in shape and distribution throughout the visual field. A scalar-product measure showed both K1 and K2.1 mfVEPs from central and some peripheral elements were statistically distinct from noise. CONCLUSIONS mfVEPs can be reliably recorded from non-human primates anesthetized with pentobarbital. Under the recording conditions described, mfVEPs are not contaminated by ERG activity. mfVEPs may be useful in animal models of diseases that differentially affect macular and peripheral visual field responsiveness.
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Affiliation(s)
- Nathan A Maertz
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792-3220, USA
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Verrotti A, Lobefalo L, Tocco AM, Spalice A, Gallenga PE, Chiarelli F, Iannetti P. Color vision and macular recovery time in epileptic adolescents treated with valproate and carbamazepine. Eur J Neurol 2006; 13:736-41. [PMID: 16834703 DOI: 10.1111/j.1468-1331.2006.01213.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Visual dysfunction has been reported in patients diagnosed with epilepsy. Some of these visual disturbances may be attributable to either the disease process, or the anticonvulsant therapy prescribed to control the seizures. The aims of our study were to evaluate whether color vision and macular function are impaired in epileptic adolescents, to study if the monotherapy with valproic acid (VPA) and carbamazepine (CBZ) can affect color vision and macular function and to determine the possible relationship between color vision, retinal function and antiepileptic drugs (AEDs) dosage and their serum concentrations. We examined 45 (16 male and 29 female, mean age +/- SD, 15.71 +/- 2.01 years) Caucasian epileptic patients suffering from various types of cryptogenic epilepsy before the beginning of therapy and after 1 year of VPA or CBZ monotherapy and 40 sex- and age-matched healthy controls. Color vision was assessed by Farnsworth Munsell (FM) 100-hue test and total error score (TES) was evaluated. This test consists of colored caps: the testee has to arrange the caps according to their colors macular function was assessed by nyctometry evaluating initial recovery time (IRT) and summation method (SM). This test evaluates visual acuity after a period of intense illumination of macula. Analysis of variance was used to evaluate the difference between controls and patients; moreover, Pearson's correlation test have been performed. Before the beginning of therapy, there were no differences in color vision and macular function between controls and epileptic patients. After 1 year, the patients, treated with VPA or CBZ, showed a deficit in FM 100-hue test. At nyctometry, all patients showed no significant variation of macular function between baseline evaluation and second evaluation at end of the follow-up. Our study demonstrates that, in our group of epileptic patients, epilepsy per se does not affect color vision and retinal function. In contrast, after 1 years of therapy with VPA and CBZ these patients showed a deficit in FM 100-hue test although nyctometry evaluation continued to be normal allowing to exclude an impairment in macular function. Further investigations are required to determine the pathophysiological alteration(s) that are at the basis of color perception defects.
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Affiliation(s)
- A Verrotti
- Department of Pediatrics, University of Chieti, Chieti, Italy.
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Galeotti F, Truini A, Iannetti GD, Romaniello A, Biasiotta A, Mascia A, Virtuoso M, Cruccu G. Laser evoked potentials and carbamazepine in epileptic patients. Neurophysiol Clin 2005; 35:93-6. [PMID: 16087072 DOI: 10.1016/j.neucli.2005.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Accepted: 01/25/2005] [Indexed: 10/25/2022] Open
Abstract
AIMS OF THE STUDY Nerve conduction studies have demonstrated that carbamazepine (CBZ), as well as other antiepileptic drugs (AEDs), can affect peripheral nerve conduction; reports on conventional somatosensory evoked potentials and CBZ are controversial. In a previous study, assessing laser-evoked potentials (LEPs) in CBZ-treated patients with idiopathic trigeminal neuralgia, we found that LEPs were dampened even after stimulation of the non-painful side, with a strong correlation between LEP latency and daily CBZ dose. No other study investigated the influence of AEDs on LEPs. In order to clarify the effect of CBZ on LEPs we sought possible LEP changes in epileptic patients taking CBZ. MATERIALS AND METHODS We studied LEPs after trigeminal and hand CO(2)-laser stimulation in 20 patients with epilepsy taking CBZ and 20 age-matched controls. RESULTS Although the trigeminal LEP mean latency was slightly longer in epileptic patients (P=0.11), we did not find significant differences between epileptic patients and controls for any LEP data. LEP data did not correlate with the daily CBZ dose, CBZ blood concentration, or duration of therapy (P>0.3). CONCLUSION The lack of a CBZ-induced dampening of LEPs suggests that small-fibre pathways, compared to large-fibre, might be less susceptible to AED's toxic effect. Although the TN patients in our previous study were older than the epileptic patients in the present study, a possible combined effect induced by drug and age in patients with TN is unlikely because LEP latency is reportedly unaffected by age. The CBZ-induced effect in patients with trigeminal neuralgia is possibly related to pathophysiological changes specific to this disease.
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Affiliation(s)
- F Galeotti
- Department of Neurological Sciences, University La Sapienza, Rome, Italy
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Genç BO, Genç E, Güney F, Ilhan N. Pattern-reversal Visual Evoked Potentials in Patients with Newly Diagnosed Epilepsy. Epilepsia 2005; 46:1219-23. [PMID: 16060931 DOI: 10.1111/j.1528-1167.2005.63504.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The possible occurrence of evoked potential (EP) abnormalities in patients with newly diagnosed epilepsy has been little investigated. The main purpose of the present study was to investigate possible changes in pattern-reversal visual evoked potential (P-VEP) responses in newly diagnosed epilepsy patients. METHODS By using P-VEPs, latency values of the N75 and P100 together with amplitude values of P100 were recorded in newly diagnosed idiopathic epilepsy patients. The patients comprised two groups; nonphotosensitive (non-PS), and photosensitive (PS) patients. RESULTS Shortened N75 and normal P100 latencies of the P-VEP with higher than normal P100 amplitudes were detected in PS patients. In non-PS patients, N75 latencies of the P-VEPs were unaffected; however, P100 latencies were prolonged, and P100 amplitudes were unchanged. CONCLUSIONS P-VEPs are different from those of controls in previously untreated idiopathic epilepsy patients. Results also indicate different P-VEP features in patients with and without photoparoxysmal responses. The changes might be the result of a disorder of one or more neurotransmitters or subtle morphologic damage such as microdysgenesis.
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Affiliation(s)
- Bülent O Genç
- Department of Neurology, Meram Faculty of Medicine, Selçuk University, Konya, Turkey.
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Geller AM, Hudnell HK, Vaughn BV, Messenheimer JA, Boyes WK. Epilepsy and Medication Effects on the Pattern Visual Evoked Potential*. Doc Ophthalmol 2005; 110:121-31. [PMID: 16249963 DOI: 10.1007/s10633-005-7350-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Visual disruption in patients diagnosed with epilepsy may be attributable to either the disease itself or to the anti-epileptic drugs prescribed to control the seizures. Effects on visual function may be due to perturbations of the GABAergic neurotransmitter system, since deficits in GABAergic cortical interneurons have been hypothesized to underlie some forms of epilepsy, some anti-epileptic medications increase cortical GABA levels, and GABAergic neural circuitry plays an important role in mediating the responses of cells in the visual cortex and retina. This paper characterizes the effects of epilepsy and epilepsy medications on the visual evoked response to patterned stimuli. Steady-state visual evoked potentials (VEP) evoked by onset-offset modulation of high-contrast sine-wave stimuli were measured in 24 control and 54 epileptic patients. Comparisons of VEP spectral amplitude as a function of spatial frequency were made between controls, complex partial, and generalized epilepsy groups. The effects of the GABA-active medication valproate were compared to those of carbamezepine. The amplitude of the fundamental (F1) component of the VEP was found to be sensitive to epilepsy type. Test subjects with generalized epilepsy had F1 spatial frequency-amplitude functions with peaks shifted to lower spatial frequencies relative to controls and test subjects with complex partial epilepsy. This shift may be due to reduced intracortical inhibition in the subjects with generalized epilepsy. The second harmonic component (F2) response was sensitive to medication effects. Complex partial epilepsy patients on VPA therapies showed reduced F2 response amplitude across spatial frequencies, consistent with previous findings that showed the F2 response is sensitive to GABA-ergic effects on transient components of the VEP.
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Affiliation(s)
- Andrew M Geller
- Neurotoxicology Division, National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, Research Triangle Park, NC 27711, USA.
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Wakamoto H, Kume A, Nakano N. Elevated pitch perception owing to carbamazepine-activating effect on the peripheral auditory system: auditory brainstem response study. J Child Neurol 2004; 19:453-5. [PMID: 15446396 DOI: 10.1177/088307380401900611] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Auditory disturbance is an uncommon side effect of carbamazepine, the pathophysiologic mechanism of which has not been clearly elucidated. We performed an auditory brainstem response study in a 9-year-old boy with epilepsy who had suffered from falsely higher pitch perception immediately after the start of carbamazepine treatment. The auditory brainstem response results showed that both the peak latency of wave V and the interpeak latencies of waves I to V were significantly prolonged with 85 dB HL click stimulation and that the peak amplitudes of the waves were noticeably elevated, particularly with lower click stimulation intensity. Although it has been shown that carbamazepine has a suppressive effect on the central nervous system, these auditory brainstem response findings might constitute evidence of a carbamazepine-activating effect on the peripheral auditory system, which probably increased the sensitivity to low-pitched sounds, causing the development of falsely higher pitch perception in our patient.
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Affiliation(s)
- Hiroyuki Wakamoto
- Department of Pediatrics, Ehime Prefecture Niihama Hospital, Niihama City, Japan.
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Abstract
Visual disturbances are a common side-effect of many antiepileptic drugs. Non-specific retino- and neurotoxic visual abnormalities, that are often reported with over-dosage and prolonged AED use, include diplopia, blurred vision and nystagmus. Some anticonvulsants are associated with specific visual problems that may be related to the mechanistic properties of the drug, and occur even when the drugs are administered within the recommended daily dose. Vigabatrin, a GABA-transaminase inhibitor, has been associated with bilateral concentric visual field loss, electrophysiological changes, central visual function deficits including reduced contrast sensitivity and abnormal colour perception, and morphological alterations of the fundus and retina. Topiramate, a drug that enhances GABAergic transmission, has been associated with cases of acute closed angle glaucoma, while tiagabine, a GABA uptake inhibitor, has been investigated for a potential GABAergic effect on the visual field. Only mild neurotoxic effects have been identified for patients treated with gabapentin, a drug designed as a cyclic analogue of GABA but exhibiting an unknown mechanism while carbamazepine, an inhibitor of voltage-dependent sodium channels, has been linked with abnormal colour perception and reduced contrast sensitivity. The following review outlines the visual disturbances associated with some of the most commonly prescribed anticonvulsants. For each drug, the ocular site of potential damage and the likely mechanism responsible for the adverse visual effects is described.
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Affiliation(s)
- Emma J Roff Hilton
- Neurosciences Research Institute, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham B4 7E7, UK
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Poblano A, Belmont A, Sosa J, Ibarra J, Rosas Y, López V, Garza S. Effects of prenatal exposure to carbamazepine on brainstem auditory evoked potentials in infants of epileptic mothers. J Child Neurol 2002; 17:364-8. [PMID: 12150584 DOI: 10.1177/088307380201700510] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine if there are any correlations between carbamazepine serum levels of epileptic mothers during pregnancy and the brainstem auditory evoked potentials in their infants as an index of drug neurotoxicity in newborns exposed prenatally. We included 20 epileptic mothers with carbamazepine medication and their 20 otherwise healthy infants. The study was conducted from September 1, 1993, to December 15, 1999. Serum carbamazepine determinations were performed monthly by enzymatic immunoanalysis in the mothers, and the averages for each trimester during pregnancy were calculated. Brainstem auditory evoked potentials were performed at 10.2 +/- 4.6 weeks of postnatal life. Pearson's correlations were calculated between carbamazepine serum levels during pregnancy and waves and interwave intervals of brainstem auditory evoked potentials. Both examinations were performed without knowledge of the results of the other investigations. No alterations in the infants' brainstem auditory evoked potentials were evident, and carbamazepine determinations were within therapeutic levels. Significant Pearson's correlations between latencies of waves III and V and third trimester of carbamazepine serum concentration levels and I-V interwave intervals to third-trimester minimum serum levels of carbamazepine were found. The findings suggest that the higher carbamazepine levels in mothers are related to increased latencies in waves III and V and I-V interwave intervals in infants subclinically, which could be an early index of fetal neurotoxicity.
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Affiliation(s)
- Adrián Poblano
- Department of Neurology, National Institute of Perinatology, México City, México.
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