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Kunić S, Ibrahimagić OĆ, Smajlović D, Kunić A, Alić J, Lepuzanović M, Tirić-Čampara M, Šehanović A. Favorite colors of patients with drug-resistant epilepsy: pilot study. Acta Neurol Belg 2024; 124:905-910. [PMID: 38353897 DOI: 10.1007/s13760-023-02457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/04/2023] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To evaluate the favorite colors of patients with drug-resistant epilepsy. METHODS Following examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drugresistant epilepsy since 2010. The favorite color examination used a six-color tape and Trycolors, an online color mixing tool. The patients' color preferences were compared with those of 50 individuals without epilepsy. RESULTS Patients with drug-resistant epilepsy preferred the color blue the most (30%), significantly more yellow (p = 0.0001), and significantly less green (p < 0.0001) compared to individuals without epilepsy. By mixing these colors at a certain percentage, we obtained the Go Ben color. SIGNIFICANCE This information on preferred colors can help to improve compliance and can be utilized in designing medications and environments for patients with epilepsy.
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Affiliation(s)
- Suljo Kunić
- Department of Neurology, Primary Health Care Center Tuzla, 75000, Tuzla, Bosnia and Herzegovina.
- Medical Faculty, University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina.
| | - Omer Ć Ibrahimagić
- Medical Faculty, University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina
- Department of Neurology, University Cinical Center Tuzla, 75000, Tuzla, Bosnia and Herzegovina
| | - Dževdet Smajlović
- Medical Faculty, University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina
- Department of Neurology, University Cinical Center Tuzla, 75000, Tuzla, Bosnia and Herzegovina
| | - Amela Kunić
- Medical Faculty, University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina
- Department of Occupational Medicine, Primary Health Care Center Tuzla, 75000, Tuzla, Bosnia and Herzegovina
| | - Jasmin Alić
- Emergency Medical Service, Primary Health Care Center Lukavac, 75300, Lukavac, Bosnia and Herzegovina
| | - Muhamed Lepuzanović
- Department of Neuropsychiatry, Cantonal Hospital Bihać, 77000, Bihać, Bosnia and Herzegovina
| | - Merita Tirić-Čampara
- Department of Neurology, General Hospital Sarajevo, 71000, Sarajevo, Bosnia and Herzegovina
| | - Aida Šehanović
- Medical Faculty, University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina
- Department of Neurology, University Cinical Center Tuzla, 75000, Tuzla, Bosnia and Herzegovina
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2
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Huschner F, Głowacka-Walas J, Mills JD, Klonowska K, Lasseter K, Asara JM, Moavero R, Hertzberg C, Weschke B, Riney K, Feucht M, Scholl T, Krsek P, Nabbout R, Jansen AC, Petrák B, van Scheppingen J, Zamecnik J, Iyer A, Anink JJ, Mühlebner A, Mijnsbergen C, Lagae L, Curatolo P, Borkowska J, Sadowski K, Domańska-Pakieła D, Blazejczyk M, Jansen FE, Janson S, Urbanska M, Tempes A, Janssen B, Sijko K, Wojdan K, Jozwiak S, Kotulska K, Lehmann K, Aronica E, Jaworski J, Kwiatkowski DJ. Molecular EPISTOP, a comprehensive multi-omic analysis of blood from Tuberous Sclerosis Complex infants age birth to two years. Nat Commun 2023; 14:7664. [PMID: 37996417 PMCID: PMC10667269 DOI: 10.1038/s41467-023-42855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
We present a comprehensive multi-omic analysis of the EPISTOP prospective clinical trial of early intervention with vigabatrin for pre-symptomatic epilepsy treatment in Tuberous Sclerosis Complex (TSC), in which 93 infants with TSC were followed from birth to age 2 years, seeking biomarkers of epilepsy development. Vigabatrin had profound effects on many metabolites, increasing serum deoxycytidine monophosphate (dCMP) levels 52-fold. Most serum proteins and metabolites, and blood RNA species showed significant change with age. Thirty-nine proteins, metabolites, and genes showed significant differences between age-matched control and TSC infants. Six also showed a progressive difference in expression between control, TSC without epilepsy, and TSC with epilepsy groups. A multivariate approach using enrollment samples identified multiple 3-variable predictors of epilepsy, with the best having a positive predictive value of 0.987. This rich dataset will enable further discovery and analysis of developmental effects, and associations with seizure development in TSC.
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Affiliation(s)
| | - Jagoda Głowacka-Walas
- Transition Technologies Science, Warsaw, Poland
- Warsaw University of Technology, The Institute of Computer Science, Warsaw, Poland
| | - James D Mills
- Amsterdam UMC, University of Amsterdam, Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | | | - Kathryn Lasseter
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John M Asara
- Department of Medicine, Harvard Medical School and Division of Signal Transduction, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Rome, Italy
- Developmental Neurology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Christoph Hertzberg
- Diagnose- und Behandlungszentrum für Kinder, Vivantes-Klinikum Neukölln, Berlin, Germany
| | - Bernhard Weschke
- Department of Child Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Martha Feucht
- Epilepsy Service, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Member of ERN EpiCARE, Vienna, Austria
| | - Theresa Scholl
- Epilepsy Service, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Member of ERN EpiCARE, Vienna, Austria
| | - Pavel Krsek
- Department of Paediatric Neurology, Motol University Hospital, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Centre for Rare Epilepsies, Necker-Enfants Malades Hospital, Université Paris cité, Imagine Institute, Paris, France
| | - Anna C Jansen
- Neurogenetics Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bořivoj Petrák
- Department of Paediatric Neurology, Motol University Hospital, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Jackelien van Scheppingen
- Amsterdam UMC, University of Amsterdam, Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Josef Zamecnik
- Department. of Pathology and Molecular Medicine, Motol University Hospital, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Anand Iyer
- Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Jasper J Anink
- Amsterdam UMC, University of Amsterdam, Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Angelika Mühlebner
- Amsterdam UMC, University of Amsterdam, Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Caroline Mijnsbergen
- Amsterdam UMC, University of Amsterdam, Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Lieven Lagae
- Department of Development and Regeneration Section Pediatric Neurology, University Hospitals KU Leuven, Leuven, Belgium
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Rome, Italy
| | - Julita Borkowska
- Department of Neurology and Epileptology, member of ERN EPICARE, The Children's Memorial Health Institute, Warsaw, Poland
| | - Krzysztof Sadowski
- Department of Neurology and Epileptology, member of ERN EPICARE, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dorota Domańska-Pakieła
- Department of Neurology and Epileptology, member of ERN EPICARE, The Children's Memorial Health Institute, Warsaw, Poland
| | - Magdalena Blazejczyk
- Department of Neurology and Epileptology, member of ERN EPICARE, The Children's Memorial Health Institute, Warsaw, Poland
| | - Floor E Jansen
- Department of Child Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Malgorzata Urbanska
- Department of Neurology and Epileptology, member of ERN EPICARE, The Children's Memorial Health Institute, Warsaw, Poland
| | - Aleksandra Tempes
- International Institute of Molecular and Cell Biology, Warsaw, Poland
| | | | - Kamil Sijko
- Transition Technologies Science, Warsaw, Poland
| | - Konrad Wojdan
- Transition Technologies Science, Warsaw, Poland
- Warsaw University of Technology, Institute of Heat Engineering, Warsaw, Poland
| | - Sergiusz Jozwiak
- Department of Neurology and Epileptology, member of ERN EPICARE, The Children's Memorial Health Institute, Warsaw, Poland
- Department of Child Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kotulska
- Department of Neurology and Epileptology, member of ERN EPICARE, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Eleonora Aronica
- Amsterdam UMC, University of Amsterdam, Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede the Netherlands, Utrecht, The Netherlands
| | - Jacek Jaworski
- International Institute of Molecular and Cell Biology, Warsaw, Poland
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Schein Y, Miller KD, Han Y, Yu Y, de Alba Campomanes AG, Binenbaum G, Oatts JT. Ocular examinations, findings, and toxicity in children taking vigabatrin. J AAPOS 2022; 26:187.e1-187.e6. [PMID: 35817277 PMCID: PMC10947413 DOI: 10.1016/j.jaapos.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/21/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The antiepileptic medication vigabatrin has been associated with ocular toxicity, and close ophthalmic monitoring has been recommended; however, there is no clear consensus regarding the value and feasibility of such monitoring in children. We describe ophthalmic assessments in children in a real-world clinical setting, the incidence of vigabatrin-related ocular toxicity, and the utility of regular screening or ancillary testing in children taking vigabatrin. METHODS The medical records of children taking vigabatrin with one or more ophthalmic assessments at Children's Hospital of Philadelphia or University of California, San Francisco, between May 2010 and May 2021, were reviewed retrospectively. Abnormalities on ophthalmic examination, visual field (VF), electroretinogram (ERG), and optical coherence tomography (OCT) were reviewed and categorized as attributable to vigabatrin, possibly attributable to vigabatrin, or not attributable to vigabatrin. RESULTS A total of 1,281 assessments of 284 children (mean age, 2.09 years) were included. Of these, 283 (99.6%) had funduscopic examination(s), 37 (13.0%) had ERG, 19 (6.7%) had OCT, and 6 (2.1%) had formal VF. Rate of examinations and ERGs per child decreased over the 10-year study period. Two children (0.7%) had definite vigabatrin-related ocular toxicity, both identified on ERG. An additional 4 children (1.4%) had optic atrophy of unclear relation to vigabatrin, categorized as possible toxicity. The remaining 278 children did not have abnormal examination or testing findings attributable to vigabatrin. CONCLUSIONS The incidence of vigabatrin-related ocular toxicity in children was low in our cohort. Ocular and neurologic comorbidities and limited examinations in children make identification of such toxicity challenging and the value of screening is unclear.
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Affiliation(s)
- Yvette Schein
- Division of Ophthalmology, Children's Hospital of Philadelphia, Pennsylvania
| | | | - Ying Han
- Department of Ophthalmology, University of California, San Francisco
| | - Yinxi Yu
- Scheie Eye Institute, Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Pennsylvania
| | - Julius T Oatts
- Department of Ophthalmology, University of California, San Francisco.
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4
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O'Neill EK, Smith R. Visual electrophysiology in the assessment of toxicity and deficiency states affecting the visual system. Eye (Lond) 2021; 35:2344-2353. [PMID: 34290445 PMCID: PMC8377028 DOI: 10.1038/s41433-021-01663-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
Visual disturbance or visual failure due to toxicity of an ingested substance or a severe nutritional deficiency can present significant challenges for diagnosis and management, for instance, where an adverse reaction to a prescribed medicine is suspected. Objective assessment of visual function is important, particularly where structural changes in the retina or optic nerve have not yet occurred, as there may be a window of opportunity to mitigate or reverse visual loss. This paper reviews a number of clinical presentations where visual electrophysiological assessment has an important role in early diagnosis or management alongside clinical assessment and ocular imaging modalities. We highlight the importance of vitamin A deficiency as an easily detected marker for severe combined micronutrient deficiency.
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Affiliation(s)
- Emily K O'Neill
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK. Emily.O'
| | - Richard Smith
- Eye Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK.
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Handley SE, Šuštar M, Tekavčič Pompe M. What can visual electrophysiology tell about possible visual-field defects in paediatric patients. Eye (Lond) 2021; 35:2354-2373. [PMID: 34272512 PMCID: PMC8377065 DOI: 10.1038/s41433-021-01680-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023] Open
Abstract
Recognising a potential visual-field (VF) defect in paediatric patients might be challenging, especially in children before the age of 5 years and those with developmental delay or intellectual disability. Visual electrophysiological testing is an objective and non-invasive technique for evaluation of visual function in paediatric patients, which can characterise the location of dysfunction and differentiate between disorders of the retina, optic nerve and visual pathway. The recording of electroretinography (ERG) and visual-evoked potentials (VEP) is possible from early days of life and requires no subjective input from the patient. As the origins of ERG and VEP tests are known, the pattern of electrophysiological changes can provide information about the VF of a child unable to perform accurate perimetry. This review summarises previously published electrophysiological findings in several common types of VF defects that can be found in paediatric patients (generalised VF defect, peripheral VF loss, central scotoma, bi-temporal hemianopia, altitudinal VF defect, quadrantanopia and homonymous hemianopia). It also shares experience on using electrophysiological testing as additional functional evidence to other tests in the clinical challenge of diagnosing or excluding VF defects in complex paediatric patients. Each type of VF defect is illustrated with one or two clinical cases.
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Affiliation(s)
- Siân E. Handley
- grid.83440.3b0000000121901201UCL Great Ormond Street Institute of Child Health, London, UK ,grid.424537.30000 0004 5902 9895Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS foundation trust, London, UK
| | - Maja Šuštar
- grid.29524.380000 0004 0571 7705Unit for Visual Electrophysiology and Paediatric Ophthalmology Department, Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Manca Tekavčič Pompe
- grid.29524.380000 0004 0571 7705Unit for Visual Electrophysiology and Paediatric Ophthalmology Department, Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
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6
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Strong AD, Sturdy A, McCourt EA, Braverman RS, Singh JK, Enzenauer RW, Jung JL. Clinical Utility of Electroretinograms for Evaluating Vigabatrin Toxicity in Children. J Pediatr Ophthalmol Strabismus 2021; 58:174-179. [PMID: 34039156 DOI: 10.3928/01913913-20210111-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine changes in the clinical treatment of pediatric patients taking vigabatrin for seizure control in response to results of electroretinogram (ERG) performed for retinal toxicity screening. METHODS The authors retrospectively reviewed the medical records of patients who received ERGs at Children's Hospital of Colorado from 2009 to 2012. Age, indication for ERG, ERG data, and clinical management of vigabatrin were extracted from the records. ERGs were interpreted according to LKC Technologies normative values. A physician trained in ERG analysis interpreted each ERG. RESULTS One hundred seventy ERGs were performed during the study period, and 147 ERGs were available for analysis. Every patient received general anesthesia for the procedure. Thirty-three ERGs were performed in 29 patients specifically as screening for retinal toxicity due to vigabatrin use, and 30 were available for analysis. Within this cohort, only 2 ERGs were normal (6.6%), and 28 were abnormal (93.3%). In patients who received abnormal results, 1 patient discontinued vigabatrin in response to the screening. CONCLUSIONS In this study cohort, clinical management generally did not change in response to an abnormal screening result. Given the need for general anesthesia in the pediatric population receiving ERG testing, and minimal change in clinical decision-making in the face of abnormal results, ERG screening for retinal toxicity due to vigabatrin in the pediatric cohort should be reconsidered. [J Pediatr Ophthalmol Strabismus. 2021;58(3):174-179.].
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7
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Pasmanter N, Petersen-Jones SM. A review of electroretinography waveforms and models and their application in the dog. Vet Ophthalmol 2020; 23:418-435. [PMID: 32196872 DOI: 10.1111/vop.12759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 02/04/2023]
Abstract
Electroretinography (ERG) is a commonly used technique to study retinal function in both clinical and research ophthalmology. ERG responses can be divided into component waveforms, analysis of which can provide insight into the health and function of different types and populations of retinal cells. In dogs, ERG has been used in the characterization of normal retinal function, as well as the diagnosis of retinal diseases and measuring effects of treatment. While many components of the recorded waveform are similar across species, dogs have several notable features that should be differentiated from the responses in humans and other animals. Additionally, modifications of standard protocols, such as changing flash frequency and stimulus color, and mathematical models of ERG waveforms have been used in studies of human retinal function but have been infrequently applied to visual electrophysiology in dogs. This review provides an overview of the origins and applications of ERG in addition to potential avenues for further characterization of responses in the dog.
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Affiliation(s)
- Nathaniel Pasmanter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Simon M Petersen-Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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8
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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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9
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Ounissi M, Rodrigues C, Bienayme H, Duhamel P, Pons G, Dulac O, Nabbout R, Chiron C, Jullien V. Proposition of a Minimal Effective Dose of Vigabatrin for the Treatment of Infantile Spasms Using Pediatric and Adult Pharmacokinetic Data. J Clin Pharmacol 2018; 59:177-188. [DOI: 10.1002/jcph.1309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Marwa Ounissi
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
| | - Christelle Rodrigues
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
| | | | - Paul Duhamel
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
| | - Gérard Pons
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
| | - Olivier Dulac
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
- Reference Centre for Rare Epilepsies; APHP; Necker-Enfants Malades Hospital; Imagine institute; Paris France
| | - Rima Nabbout
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
- Reference Centre for Rare Epilepsies; APHP; Necker-Enfants Malades Hospital; Imagine institute; Paris France
| | - Catherine Chiron
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
- Reference Centre for Rare Epilepsies; APHP; Necker-Enfants Malades Hospital; Imagine institute; Paris France
| | - Vincent Jullien
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
- Service de pharmacologie; Hôpital Européen Georges Pompidou; Paris France
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10
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Pearl PL, Poduri A, Prabhu SP, Harini C, Goldstein R, Atkinson RM, Armstrong D, Kinney H. White matter spongiosis with vigabatrin therapy for infantile spasms. Epilepsia 2018; 59:e40-e44. [PMID: 29473152 DOI: 10.1111/epi.14032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 11/26/2022]
Abstract
The histopathology, "white matter spongiosis," defined by electron microscopy (EM) as "intramyelinic edema," has been associated with vigabatrin therapy in various animal models, but its role or significance in clinical studies is unknown. We conducted a neuropathological examination on a 27-month-old boy with bilateral polymicrogyria and epilepsy after sudden unexpected death in epilepsy (SUDEP). The patient was initiated on vigabatrin at 4 months of age, which controlled infantile spasms, and was continued as maintenance therapy. Autopsy showed a combination of developmental and acquired lesions: (1) bilateral gyral malformations of the frontal, parietal, temporal, and insular cortex; (2) agenesis of the olfactory tracts and bulbs; (3) hippocampal abnormalities: dentate gyrus bilamination and granule cell dispersion; and (4) areas of microscopic bilateral, symmetric white matter spongiosis in the brainstem central tegmental tract, amiculum and hilum of the inferior olive, medial longitudinal fasciculus, paragigantocellularis lateralis, optic nerves and chiasm, and hypothalamus. The white matter spongiosis was identical to the histopathologic lesions (which by EM exhibited intramyelinic edema) that were demonstrated in animal models on vigabatrin therapy, indicating that vigabatrin toxicity is not restricted to animal models.
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Affiliation(s)
- Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Annapurna Poduri
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Robert's Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanjay P Prabhu
- Robert's Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chellamani Harini
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Goldstein
- Robert's Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Dawna Armstrong
- Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Hannah Kinney
- Robert's Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Hui A, Liu D, Wong K, Man B, Leung T, Lam P, Lam D. Vigabatrin-Induced Visual Dysfunction in Chinese Patients with Refractory Epilepsy. Eur J Ophthalmol 2018; 18:624-7. [PMID: 18609486 DOI: 10.1177/112067210801800421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A.C.F. Hui
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong - PR China
| | - D.T.L. Liu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong - PR China
| | - K.K. Wong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong - PR China
| | - B.L. Man
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong - PR China
| | - T. Leung
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong - PR China
| | - P.T.H. Lam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong - PR China
| | - D.S.C. Lam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong - PR China
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Abstract
Childhood epileptic encephalopathies are age-dependent disorders of the brain whose hallmarks include loss of neurologic function over time, abnormal electroencephalographic findings, and seizures. Ictal and interictal electrographic activity are conjointly thought to be at the root of the often devastating neuropsychological deterioration, which is specific to the maturing brain. The goals of treatment are not only to control seizures, but also to prevent or reverse neurologic loss of function. In general, time is of the essence in diagnosis, and experienced specialists should promptly design a treatment plan. Hormonal and immune therapies are at the forefront of treatment in many cases, with traditional antiepileptic drugs and surgery (when an identifiable lesion is present) playing a limited role. However, gold standard evidence for treatment of epileptic encephalopathies remains limited. Ongoing clinical and basic research may lead to better understanding of these catastrophic conditions and to better and more effective therapies.
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Affiliation(s)
- Hiroki Nariai
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Susan Duberstein
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Shlomo Shinnar
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY, USA,Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY, USA
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13
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Kwok CS, Johnson EL, Krauss GL. Comparing Safety and Efficacy of "Third-Generation" Antiepileptic Drugs: Long-Term Extension and Post-marketing Treatment. CNS Drugs 2017; 31:959-974. [PMID: 29204953 DOI: 10.1007/s40263-017-0480-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Four "third-generation" antiepileptic drugs (AEDs) were approved for adjunctive treatment of refractory focal onset seizures during the past 10 years. Long-term efficacy and safety of the drugs were demonstrated in large extension studies and in reports of subgroups of patients not studied in pivotal trials. Reviewing extension study and post-marketing outcome series for the four newer AEDs-lacosamide, perampanel, eslicarbazepine acetate and brivaracetam-can guide clinicians in treating and monitoring patients. AED extension studies evaluate treatment retention, drug tolerability, and drug safety during individualized treatment with flexible dosing and thus provide information not available in rigid pivotal trials. Patient retention in the studies ranged from 75 to 80% at 1 year and from 36 to 68% at 2-year treatment intervals. Safety findings were generally similar to those of pivotal trials, with no major safety risks identified and with several specific adverse drug effects, such as hyponatremia, reported. The third-generation AEDs, some through new mechanisms and others with improved tolerability compared to related AEDs, provide new options in efficacy and tolerability.
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Affiliation(s)
- Charlotte S Kwok
- Department of Neurology, Johns Hopkins University, Meyer 2-147, 600 N. Wolfe St, Baltimore, MD, 21210, USA
| | - Emily L Johnson
- Department of Neurology, Johns Hopkins University, Meyer 2-147, 600 N. Wolfe St, Baltimore, MD, 21210, USA
| | - Gregory L Krauss
- Department of Neurology, Johns Hopkins University, Meyer 2-147, 600 N. Wolfe St, Baltimore, MD, 21210, USA.
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14
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LaPenna P, Tormoehlen LM. The Pharmacology and Toxicology of Third-Generation Anticonvulsant Drugs. J Med Toxicol 2017; 13:329-342. [PMID: 28815428 DOI: 10.1007/s13181-017-0626-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/09/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022] Open
Abstract
Epilepsy is a neurologic disorder affecting approximately 50 million people worldwide, or about 0.7% of the population [1]. Thus, the use of anticonvulsant drugs in the treatment of epilepsy is common and widespread. There are three generations of anticonvulsant drugs, categorized by the year in which they were developed and released. The aim of this review is to discuss the pharmacokinetics, drug-drug interactions, and adverse events of the third generation of anticonvulsant drugs. Where available, overdose data will be included. The pharmacokinetic properties of third-generation anticonvulsant drugs include relatively fewer drug-drug interactions, as well as several unique and life-threatening adverse events. Overdose data are limited, so thorough review of adverse events and knowledge of drug mechanism will guide expectant management of future overdose cases. Reporting of these cases as they occur will be necessary to further clarify toxicity of these drugs.
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Affiliation(s)
- Paul LaPenna
- Department of Neurology, Indiana University, 355 W. 16th Street, Suite 3200, Indianapolis, IN, 46202, USA
| | - Laura M Tormoehlen
- Department of Neurology, Indiana University, 355 W. 16th Street, Suite 3200, Indianapolis, IN, 46202, USA. .,Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA.
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15
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Tuğcu B, Bitnel MK, Kaya FS, Güveli BT, Ataklı D. Evaluation of inner retinal layers with optic coherence tomography in vigabatrin-exposed patients. Neurol Sci 2017; 38:1423-1427. [PMID: 28508989 DOI: 10.1007/s10072-017-2971-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/19/2017] [Indexed: 11/24/2022]
Abstract
In order to reveal the underlying retinal pathology leading to dysfunction in vigabatrin-exposed patients, we aimed to evaluate the inner retinal layers encompassing ganglion cell complex (GCC) layer and inner plexiform layer with new generation optic coherence tomography (OCT). Fourteen patients with epilepsy and exposure to vigabatrin and 12 clinically normal individuals, constituting the control group, were included. Retinal images were obtained using spectral-domain OCT (Optovue RTVue Fourier domain). Nasal and superior quadrants of retinal nerve fiber layer (RNFL) were found to be significantly lower in the patient group compared to the controls (p < 0.01). No significant difference was shown in the thickness of GCC layer (p > 0.05). Foveal thickness was significantly higher in the patient group (p: 0.006), but no significant difference was found in perifoveal and parafoveal regions between groups (p > 0.05). The thickness of RNFL was found to be lower in vigabatrin-exposed patients without any reduction in GCC layer in the macular region. However, foveal thickness was found to be significantly higher compared to perifoveal and parafoveal macular regions in vigabatrin-exposed patients. In conclusion, OCT revealed reduced thickness of RNFL without any reduction in ganglion cell layer in our study. The objective quantitative assessment of OCT is a practical noninvasive method and it can have role in future monitoring of these patients.
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Affiliation(s)
- Betül Tuğcu
- Department of Ophthalmology, Bezmialem University Medical Faculty, İstanbul, Turkey
| | - Mesrure Köseoğlu Bitnel
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Bakırköy, 34147, Istanbul, Turkey
| | - Fatma Selin Kaya
- Department of Eye Clinic, Bakırköy Dr. Sadi Konuk Research and Training Hospital, İstanbul, Turkey
| | - Betül Tekin Güveli
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Bakırköy, 34147, Istanbul, Turkey.
| | - Dilek Ataklı
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Bakırköy, 34147, Istanbul, Turkey
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16
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Vogel KR, Ainslie GR, Schmidt MA, Wisor JP, Gibson KM. mTOR Inhibition Mitigates Molecular and Biochemical Alterations of Vigabatrin-Induced Visual Field Toxicity in Mice. Pediatr Neurol 2017; 66:44-52.e1. [PMID: 27816307 PMCID: PMC5866057 DOI: 10.1016/j.pediatrneurol.2016.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/21/2016] [Accepted: 09/25/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Gamma-vinyl-γ-aminobutyric acid (GABA) (vigabatrin) is an antiepileptic drug and irreversible GABA transaminase inhibitor associated with visual field impairment, which limits its clinical utility. We sought to relate altered visual evoked potentials associated with vigabatrin intake to transcriptional changes in the mechanistic target of rapamycin (mTOR) pathway and GABA receptors to expose further mechanisms of vigabatrin-induced visual field loss. METHODS Vigabatrin was administered to mice via an osmotic pump for two weeks to increase GABA levels. Visual evoked potentials were examined, eye samples were collected, and gene expression was measured by quantitative reverse transcription-polymerase chain reaction. Similarly, human retinal pigment epithelial cells (ARPE19) were exposed to vigabatrin and treated with mTOR inhibitors for mTOR pathway analysis and to assess alterations in organelle accumulation by microscopy. RESULTS Dysregulated expression of transcripts in the mTOR pathway, GABAA/B receptors, metabotropic glutamate (Glu) receptors 1/6, and GABA/glutamate transporters in the eye were found in association with visual evoked potential changes during vigabatrin administration. Rrag genes were upregulated in both mouse eye and ARPE19 cells. Immunoblot of whole eye revealed greater than three fold upregulation of a 200 kDa band when immunoblotted for ras-related guanosine triphosphate binding D. Microscopy of ARPE19 cells revealed selective reversal of vigabatrin-induced organelle accumulation by autophagy-inducing drugs, notably Torin 2. Changes in the mTOR pathway gene expression, including Rrag genes, were corrected by Torin 2 in ARPE19 cells. CONCLUSIONS Our studies, indicating GABA-associated augmentation of RRAG and mTOR signaling, support further preclinical evaluation of mTOR inhibitors as a therapeutic strategy to potentially mitigate vigabatrin-induced ocular toxicity.
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Affiliation(s)
- Kara R Vogel
- Division of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, Washington
| | - Garrett R Ainslie
- Division of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, Washington
| | - Michelle A Schmidt
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Jonathan P Wisor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - K Michael Gibson
- Division of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, Washington.
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17
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Sergott RC, Johnson CA, Laxer KD, Wechsler RT, Cherny K, Whittle J, Feng G, Lee D, Isojarvi J. Retinal structure and function in vigabatrin‐treated adult patients with refractory complex partial seizures. Epilepsia 2016; 57:1634-1642. [DOI: 10.1111/epi.13495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Robert C. Sergott
- Wills Eye Institute and Thomas Jefferson University Medical College Philadelphia Pennsylvania U.S.A
| | - Chris A. Johnson
- Department of Ophthalmology & Visual Sciences University of Iowa Hospitals & Clinics Iowa City Iowa U.S.A
| | - Kenneth D. Laxer
- California Pacific Medical Center San Francisco California U.S.A
| | | | | | | | - Ge Feng
- Lundbeck LLC Deerfield Illinois U.S.A
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18
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Pietilä S, Lenko HL, Oja S, Koivisto AM, Pietilä T, Mäkipernaa A. Electroretinography and Visual Evoked Potentials in Childhood Brain Tumor Survivors. J Child Neurol 2016; 31:998-1004. [PMID: 26945030 DOI: 10.1177/0883073816634863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
Abstract
This population-based cross-sectional study evaluates the clinical value of electroretinography and visual evoked potentials in childhood brain tumor survivors. A flash electroretinography and a checkerboard reversal pattern visual evoked potential (or alternatively a flash visual evoked potential) were done for 51 survivors (age 3.8-28.7 years) after a mean follow-up time of 7.6 (1.5-15.1) years. Abnormal electroretinography was obtained in 1 case, bilaterally delayed abnormal visual evoked potentials in 22/51 (43%) cases. Nine of 25 patients with infratentorial tumor location, and altogether 12 out of 31 (39%) patients who did not have tumors involving the visual pathways, had abnormal visual evoked potentials. Abnormal electroretinographies are rarely observed, but abnormal visual evoked potentials are common even without evident anatomic lesions in the visual pathway. Bilateral changes suggest a general and possibly multifactorial toxic/adverse effect on the visual pathway. Electroretinography and visual evoked potential may have clinical and scientific value while evaluating long-term effects of childhood brain tumors and tumor treatment.
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Affiliation(s)
| | - Hanna L Lenko
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Sakari Oja
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | | | - Timo Pietilä
- Department of Neurology, Hatanpää Hospital, Tampere, Finland
| | - Anne Mäkipernaa
- Department of Hematology, Cancer Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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19
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Pellock JM, Faught E, Foroozan R, Sergott RC, Shields WD, Ziemann A, Lee D, Dribinsky Y, Torri S, Othman F, Isojarvi J. Which children receive vigabatrin? Characteristics of pediatric patients enrolled in the mandatory FDA registry. Epilepsy Behav 2016; 60:174-180. [PMID: 27208827 DOI: 10.1016/j.yebeh.2016.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/21/2016] [Indexed: 10/21/2022]
Abstract
Vigabatrin (Sabril®) is an antiepileptic drug (AED) currently indicated in the US as a monotherapy for patients 1month to 2years of age with infantile spasms (IS) and as adjunctive therapy for patients ≥10years of age with refractory complex partial seizures (rCPS) whose seizures have inadequately responded to several alternative treatments and for whom the potential benefits outweigh the risk of vision loss. The approval required an FDA mandated registry. This article describes 5years of demographic and treatment exposure data from US pediatric patients (<17years). Participation is mandatory for all US Sabril® prescribers and patients. A benefit-risk assessment must be documented for patient progression to maintenance therapy. This includes demographic diagnosis and reports of ophthalmologic assessments (where available). Patient data were grouped by age as proxies for indication (IS: <3years, rCPS: ≥3 to <17years). As of August 26, 2014, 5546/6823 enrolled patients were pediatric/total; 4472 (81%) were vigabatrin-naïve. Seventy-one percent of patients were <3years of age; 29% were ≥3 to <17years of age. Etiologies of IS were identified as cryptogenic (21%), symptomatic tuberous sclerosis (17%), and symptomatic other (42%). The majority of patients with IS (56%) attempted no prior treatments; 16% received adrenocorticotropic hormone prior to vigabatrin. A third of patients with IS were receiving 1 concomitant treatment with vigabatrin. For patients with rCPS, 39% attempted 1-3 prior treatments; 27% were receiving 2 concomitant treatments at enrollment. A total of 1852 (41%) patients did not undergo baseline ophthalmological assessment; 25% of patients with IS and 42% of patients with rCPS were exempted for neurologic disabilities. Kaplan-Meier estimates predict that 71% and 65% of vigabatrin-naïve patients with IS and rCPS, respectively, would remain in the registry at 6months. Most pediatric vigabatrin patients have IS as an underlying diagnosis, especially those <3years of age. A proportion of those with rCPS remain on long-term vigabatrin despite the risk of adverse events.
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Affiliation(s)
| | | | | | - Robert C Sergott
- Wills Eye Institute and Thomas Jefferson University Medical College, Philadelphia, PA, USA
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20
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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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21
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Krauss G, Faught E, Foroozan R, Pellock JM, Sergott RC, Shields WD, Ziemann A, Dribinsky Y, Lee D, Torri S, Othman F, Isojarvi J. Sabril® registry 5-year results: Characteristics of adult patients treated with vigabatrin. Epilepsy Behav 2016; 56:15-9. [PMID: 26807550 DOI: 10.1016/j.yebeh.2015.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 11/16/2022]
Abstract
Vigabatrin (Sabril®), approved in the US in 2009, is currently indicated as adjunctive therapy for refractory complex partial seizures (rCPS) in patients ≥ 10 years old who have responded inadequately to several alternative treatments and as monotherapy for infantile spasms (IS) in patients 1 month to 2 years of age. Because of reports of vision loss following vigabatrin exposure, FDA approval required a risk evaluation mitigation strategy (REMS) program. Vigabatrin is only available in the US through Support, Help, And Resources for Epilepsy (SHARE), which includes a mandated registry. This article describes 5 years of demographic and treatment exposure data from adult patients (≥ 17 years old) in the US treated with vigabatrin and monitored in the ongoing Sabril® registry. Registry participation is mandatory for all US Sabril® prescribers and patients. A benefit-risk assessment must be documented by the physician for a patient to progress to maintenance therapy, defined as 1 month of vigabatrin treatment for patients with IS and 3 months for patients with rCPS. Ophthalmologic assessments must be documented during and after completion of therapy. As of August 26, 2014, a total of 6823 patients were enrolled in the registry, of which 1200 were adults at enrollment. Of these patients, 1031 (86%) were naïve to vigabatrin. The majority of adult patients (n=783, 65%) had previously been prescribed ≥ 4 AEDs, and 719 (60%) were receiving ≥ 3 concomitant AEDs at vigabatrin initiation. Prescribers submitted an initial ophthalmological assessment form for 863 patients; an ophthalmologic exam was not completed for 300 (35%) patients and thus, were considered exempted from vision testing. Of these patients, 128 (43%) were exempted for neurologic disabilities. Clinicians discontinued treatment in 8 patients because of visual field deficits (VFD) (5 patients naïve to vigabatrin and 3 patients previously exposed). Based on Kaplan-Meier survival estimates, it is estimated that approximately 71%, 55%, and 40% of adult patients naïve to vigabatrin would remain in the registry at 3, 6, and 12 months, respectively. These demographic data suggest that a proportion of adult patients remain on vigabatrin long-term despite the risks of adverse events and significant underlying AED resistance and neurologic disease.
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Affiliation(s)
| | | | | | | | - Robert C Sergott
- Wills Eye Institute and Thomas Jefferson University Medical College, Philadelphia, PA, USA
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Moreno MC, Giagante B, Saidon P, Kochen S, Benozzi J, Rosenstein RE. Visual Defects Associated with Vigabatrin: A Study of Epileptic Argentine Patients. Can J Neurol Sci 2014; 32:459-64. [PMID: 16408575 DOI: 10.1017/s0317167100004443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT:Objective:The aim of the present study was to assess visual alterations in a population of Argentine patients treated with the antiepileptic drug vigabatrin.Methods:Twenty patients receiving vigabatrin and 15 patients receiving carbamazepine were examined with automated perimetry using a Humphrey 120-point full screening strategy. In addition, scotopic flash electroretinograms were performed.Results:Of 20 patients treated with vigabatrin, two were unable to cooperate with testing. Of the remaining 18 patients, all but two showed at least one non-detected point inside the central 40° of the visual field of each eye. Of the 15 carbamazepine-treated patients, three were unable to perform the study. None of the remaining 12 patients showed visual field defects. Both a- and b-wave amplitudes of the scotopic electroretinogram were significantly reduced in 12 patients receiving vigabatrin.Conclusions:Visual field defects among patients on vigabatrin therapy may occur with a higher frequency than previously recognized. The Humphrey 120-points full field screening test and electroretinography are useful tools to assess the visual dysfunction associated with vigabatrin.
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Affiliation(s)
- María Cecilia Moreno
- Laboratory of Retinal Neurochemistry, Epilepsy Center, Ramos Mejia Hospital, School of Medicine, University of Buenos Aires, Paraguay 2155, 50 P, Buenos Aires, Argentina
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23
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Zrenner E, Tomaszewski K, Hamlin J, Layton G, Wood N. Effects of multiple doses of voriconazole on the vision of healthy volunteers: a double-blind, placebo-controlled study. Ophthalmic Res 2014; 52:43-52. [PMID: 24925440 DOI: 10.1159/000359952] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 01/22/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the effects, and their reversibility, of multiple oral voriconazole doses on a variety of visual tests in healthy male volunteers. METHODS Single-center, double-blind, randomized, placebo-controlled, parallel-group study in 36 volunteers who received voriconazole (n=18, 400 mg every 12 h on day 1, then 300 mg every 12 h for 27.5 days) or matched placebo (n=18). Electroretinograms (ERGs) and ophthalmological examinations were performed at screening, throughout the study and at follow-up. RESULTS Fifteen (83.3%) volunteers treated with voriconazole experienced ≥1 treatment-related visual adverse events (AEs); these included enhanced visual perceptions, blurred vision, color vision changes and photophobia. No serious AEs were reported. Voriconazole reduced from baseline scotopic maximal a- and b-wave amplitude, shortened implicit time and decreased oscillatory potential amplitude compared with placebo. Under photopic conditions, the 30-Hz flicker response amplitude was significantly reduced and was accompanied by a slight but nonsignificant prolongation of peak time. These effects did not progress in degree over the treatment period, and mean changes from baseline in ERG parameters were similar to placebo by day 43 (14 days after end of treatment). In the first week, color vision discrimination was impaired in the tritan axis, although this resolved by end of treatment and was similar to placebo by day 43. Mean deviation in the static visual field indicated increased sensitivity following voriconazole treatment, correlating with decreased amplitude in conjunction with shortened implicit time. CONCLUSIONS Effects of voriconazole on altered visual perception, ERG, color vision and static visual field thresholds are nonprogressive over a treatment period and reversible. It is hypothesized that voriconazole has a pharmacological effect on rod and cone pathways including a possible mechanism of disinhibition that reversibly puts the retina in a more light-adapted state and leads to increased relative contrast sensitivity.
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Affiliation(s)
- Eberhart Zrenner
- Center of Integrative Neuroscience and Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
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24
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Froger N, Moutsimilli L, Cadetti L, Jammoul F, Wang QP, Fan Y, Gaucher D, Rosolen SG, Neveux N, Cynober L, Sahel JA, Picaud S. Taurine: the comeback of a neutraceutical in the prevention of retinal degenerations. Prog Retin Eye Res 2014; 41:44-63. [PMID: 24721186 DOI: 10.1016/j.preteyeres.2014.03.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 12/21/2022]
Abstract
Taurine is the most abundant amino acid in the retina. In the 1970s, it was thought to be involved in retinal diseases with photoreceptor degeneration, because cats on a taurine-free diet presented photoreceptor loss. However, with the exception of its introduction into baby milk and parenteral nutrition, taurine has not yet been incorporated into any commercial treatment with the aim of slowing photoreceptor degeneration. Our recent discovery that taurine depletion is involved in the retinal toxicity of the antiepileptic drug vigabatrin has returned taurine to the limelight in the field of neuroprotection. However, although the retinal toxicity of vigabatrin principally involves a deleterious effect on photoreceptors, retinal ganglion cells (RGCs) are also affected. These findings led us to investigate the possible role of taurine depletion in retinal diseases with RGC degeneration, such as glaucoma and diabetic retinopathy. The major antioxidant properties of taurine may influence disease processes. In addition, the efficacy of taurine is dependent on its uptake into retinal cells, microvascular endothelial cells and the retinal pigment epithelium. Disturbances of retinal vascular perfusion in these retinal diseases may therefore affect the retinal uptake of taurine, resulting in local depletion. The low plasma taurine concentrations observed in diabetic patients may further enhance such local decreases in taurine concentration. We here review the evidence for a role of taurine in retinal ganglion cell survival and studies suggesting that this compound may be involved in the pathophysiology of glaucoma or diabetic retinopathy. Along with other antioxidant molecules, taurine should therefore be seriously reconsidered as a potential treatment for such retinal diseases.
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Affiliation(s)
- Nicolas Froger
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France.
| | - Larissa Moutsimilli
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Lucia Cadetti
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Firas Jammoul
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Qing-Ping Wang
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Yichao Fan
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - David Gaucher
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; Nouvel hôpital civil, hôpitaux universitaires de Strasbourg and Laboratoire de Bactériologie (EA-7290), Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France
| | - Serge G Rosolen
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Nathalie Neveux
- Department of Nutrition, Faculty of Pharmacy, Paris Descartes University, Paris, France; Clinical Chemistry, Hôtel-Dieu-Cochin Hospitals, AP-HP, Paris, France
| | - Luc Cynober
- Department of Nutrition, Faculty of Pharmacy, Paris Descartes University, Paris, France; Clinical Chemistry, Hôtel-Dieu-Cochin Hospitals, AP-HP, Paris, France
| | - José-Alain Sahel
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; Institute of Ophthalmology, University College of London, UK; Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; French Academy of Sciences, Paris, France
| | - Serge Picaud
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France; Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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Curatolo P, D’Argenzio L, Cerminara C, Bombardieri R. Management of epilepsy in tuberous sclerosis complex. Expert Rev Neurother 2014; 8:457-67. [DOI: 10.1586/14737175.8.3.457] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barrett D, Yang J, Sujirakul T, Tsang SH. Vigabatrin Retinal Toxicity First Detected with Electroretinographic Changes: A Case Report. ACTA ACUST UNITED AC 2014; 5. [PMID: 26295007 DOI: 10.4172/2155-9570.1000363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Vigabatrin is an effective antiepileptic drug (AED) typically used in the treatment of refractory partial seizures and infantile spasms. Its use, however, is limited due to the concern of retinal toxicity and subsequent visual field defects. Herewith in we describe a case of vigabatrin toxicity that illustrates electroretinographic (ERG) changes occur before imaging and visual field deterioration. Decrease in maximal ERG b: a ratio was observed before thinning of the retinal nerve fiber layer (RNFL) on optical coherence tomography (OCT).
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Affiliation(s)
- Dianne Barrett
- College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Jin Yang
- Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA
| | - Tharikarn Sujirakul
- Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA
| | - Stephen H Tsang
- Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA ; Bernard & Shirlee Brown Glaucoma Laboratory, Departments of Ophthalmology, Pathology & Cell Biology, Columbia University, New York, NY 10032, USA ; New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY 10032, USA
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Briggs SW, Mowrey W, Hall CB, Galanopoulou AS. CPP-115, a vigabatrin analogue, decreases spasms in the multiple-hit rat model of infantile spasms. Epilepsia 2013; 55:94-102. [PMID: 24321005 DOI: 10.1111/epi.12424] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Infantile spasms (IS) have poor outcomes and limited treatment options, including vigabatrin, a γ-aminobutyric acid (GABA) aminotransferase inactivator. Vigabatrin has been associated with retinal toxicity. A high affinity vigabatrin analogue (CPP-115; Catalyst Pharmaceutical Partners, Inc., Coral Gables, FL, U.S.A.) has shown lower risk of retinal toxicity. Here, we test the efficacy of CPP-115 in reducing spasms and its tolerability in the multiple-hit rat model of IS, in which daily vigabatrin reduced spasms for only one day, but was not well tolerated. METHODS Male rats were treated with the protocol of the multiple-hit model of IS on postnatal day 3 (PN3). Using a randomized, blinded, vehicle-controlled, dose-response study design, CPP-115 (0.1, 1, or 5 mg/kg intraperitoneally [i.p.]) or vehicle was given daily (PN4-12) or as a single injection (PN7) after spasm onset. Intermittent video- or video-electroencephalography (EEG) monitoring was done. Secondary end points included the following: daily weights, survival, performance on open field activity, surface righting time, and negative geotaxis (PN3-20), horizontal bar (PN13-20), and Barnes maze (PN16-19). Statistics used a linear mixed model of raw or normalized log-transformed data, taking into account the repeated observations on each animal. RESULTS The lower CPP-115 doses (0.1-1 mg/kg/day, PN4-12) reduced spasms between PN6 and 7 without increasing mortality. CPP-115 at 5 mg/kg/day (PN4-12) reduced spasms earlier (PN5), but was eventually lethal. A single CPP-115 injection (1 mg/kg, i.p.) decreased electroclinical spasms acutely but transiently. CPP-115 transiently improved the probability to >50% reduction of spasms, but did not accelerate spasm cessation. CPP-115 did not alter neurodevelopmental outcomes or visuospatial learning. SIGNIFICANCE We provide proof-of-concept evidence that CPP-115, a vigabatrin analogue, decreases spasms in the multiple-hit rat model of IS at considerably lower and better tolerated doses than vigabatrin did in our previous studies. Further optimization of the treatment protocol is needed. CPP-115 may be a promising new candidate treatment for IS with better tolerability than vigabatrin.
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Affiliation(s)
- Stephen W Briggs
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, U.S.A; Laboratory of Developmental Epilepsy and Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, U.S.A
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Wild JM, Fone DL, Aljarudi S, Lawthom C, Smith PEM, Newcombe RG, Lewis GD. Modelling the risk of visual field loss arising from long-term exposure to the antiepileptic drug vigabatrin: a cross-sectional approach. CNS Drugs 2013; 27:841-9. [PMID: 23990316 DOI: 10.1007/s40263-013-0100-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The antiepileptic drug vigabatrin has been used widely since 1989, but has only been approved for use in the US since 2009. The risk:benefit of vigabatrin is generally predicated upon an assumed frequency of associated visual field loss (VAVFL) of approximately 31 %. This estimate is based upon relatively short-term usage (up to 4-5 years) and it is essential to determine whether the frequency of VAVFL increases with longer-term usage. OBJECTIVE The aim of this study was to model, from cross-sectional evidence, over greater ranges of treatment duration and cumulative dose than previously evaluated, the risk (frequency) of VAVFL with increasing exposure to vigabatrin. STUDY DESIGN AND SETTING This was a retrospective cohort study undertaken in a regional hospital epilepsy clinic. PATIENTS The cohort comprised 147 consecutive patients treated with vigabatrin for refractory complex partial (focal) seizures, who had all undergone ophthalmological examination and who had undertaken perimetry, reliably, according to a standard and robust protocol. The visual field plots were evaluated masked to treatment duration and dose. MAIN OUTCOME MEASURE The risk (frequency) of VAVFL with increasing exposure to vigabatrin was modelled, from the cross-sectional evidence, by standard and plateau logistic regression. RESULTS The cohort comprised 80 females and 67 males (mean age 40.3 years, standard deviation 13.7). The median duration of vigabatrin exposure was 7.9 years (interquartile range 3.6-11.0, range 0.2-16.1 years); 46 patients (31 %) had received vigabatrin for over 10 years. Eighty-seven patients (59 %) exhibited VAVFL; the proportion with VAVFL was higher in males (66 %) than females (54 %). The plateau model for duration and for cumulative dose exhibited a better fit than the standard model (both p < 0.001). The modelled frequency of VAVFL increased with increasing exposure up to approximately 6 years duration and 5 kg cumulative dose, and plateaued at approximately 76 % (95 % CI 67-85) and 79 % (95 % CI 70-87), respectively. Severity of VAVFL, classified in terms of the visual field index Mean Deviation, was not significantly associated with either duration or cumulative dose of therapy. CONCLUSION Clinicians and patients, in enabling informed choice, should be alert to the possible substantial increased risk:benefit for VAVFL with increasing long-term exposure to vigabatrin and the ensuing increased cost:benefit resulting from the necessary additional visual assessments.
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Affiliation(s)
- John M Wild
- Cardiff Centre for Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, Wales, CF24 4HQ, UK,
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Vogel KR, Pearl PL, Theodore WH, McCarter RC, Jakobs C, Gibson KM. Thirty years beyond discovery--clinical trials in succinic semialdehyde dehydrogenase deficiency, a disorder of GABA metabolism. J Inherit Metab Dis 2013; 36:401-10. [PMID: 22739941 PMCID: PMC4349389 DOI: 10.1007/s10545-012-9499-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 05/09/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
This review summarizes a presentation made at the retirement Symposium of Prof. Dr. Cornelis Jakobs in November of 2011, highlighting the progress toward clinical trials in succinic semialdehyde dehydrogenase (SSADH) deficiency, a disorder first recognized in 1981. Active and potential clinical interventions, including vigabatrin, L-cycloserine, the GHB receptor antagonist NCS-382, and the ketogenic diet, are discussed. Several biomarkers to gauge clinical efficacy have been identified, including cerebrospinal fluid metabolites, neuropsychiatric testing, MRI, EEG, and measures of GABAergic function including (11 C)flumazenil positron emission tomography (PET) and transcranial magnetic stimulation (TMS). Thirty years after its discovery, encompassing extensive studies in both patients and the corresponding murine model, we are now running an open-label trial of taurine intervention, and are poised to undertake a phase II trial of the GABAB receptor antagonist SGS742.
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Affiliation(s)
- Kara R Vogel
- Section of Clinical Pharmacology, College of Pharmacy, Washington State University, Spokane, WA 99202-2131, USA.
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Taurine Is a Crucial Factor to Preserve Retinal Ganglion Cell Survival. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 775:69-83. [DOI: 10.1007/978-1-4614-6130-2_6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Heim MK, Gidal BE. Vigabatrin-associated retinal damage: potential biochemical mechanisms. Acta Neurol Scand 2012; 126:219-28. [PMID: 22632110 DOI: 10.1111/j.1600-0404.2012.01684.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2012] [Indexed: 12/13/2022]
Abstract
Vigabatrin (VGB), an irreversible inhibitor of gamma-aminobutyric acid (GABA) transaminase, is approved as adjunct treatment of refractory partial seizures as well as infantile spasms. Although VGB has been proven to be effective, its use is limited by the risk of retinopathy and associated peripheral visual field defects. This review describes and analyzes current literature related to potential pathophysiologic mechanisms underlying VGB-mediated cellular toxicity. Animal data suggest that GABA mediates neural excitotoxicity. The amino acid taurine is concentrated in retinal cells, and deficiency of this amino acid may be involved in VGB-mediated retinal degeneration and possible phototoxicity.
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Affiliation(s)
- M. K. Heim
- School of Pharmacy; University of Wisconsin - Madison; Madison; WI; USA
| | - B. E. Gidal
- School of Pharmacy & Department of Neurology; University of Wisconsin - Madison; Madison; WI; USA
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Abstract
PURPOSE OF REVIEW Various medications can modify the physiology of retinal and cochlear neurons and lead to major, sometime permanent, sensory loss. A better knowledge of pathogenic mechanisms and the establishment of relevant monitoring protocols are necessary to prevent permanent sensory impairment. In this article, we review main systemic medications associated with direct neuronal toxicity on the retina and cochlea, their putative pathogenic mechanisms, when identified, as well as current recommendations, when available, for monitoring protocols. RECENT FINDINGS Pathogenic mechanisms and cellular target of retinotoxic drugs are often not well characterized but a better knowledge of the course of visual defect has recently helped in defining more relevant monitoring protocols especially for antimalarials and vigabatrin. Mechanisms of ototoxicity have recently been better defined, from inner ear entry with the use of fluorescent tracers to evidence for the role of oxidative stress and program cell death pathways. SUMMARY Experimental and clinical studies have elucidated some of the pathogenic mechanisms, courses and risk factors of retinal toxicity and ototoxicity, which have led to establishment of relevant monitoring protocols. Further studies are, however, warranted to better understand cellular pathways leading to degeneration. These would help to build more efficient preventive intervention and may also contribute to understanding of other degenerative processes such as genetic disorders.
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Gilioli I, Vignoli A, Visani E, Casazza M, Canafoglia L, Chiesa V, Gardella E, La Briola F, Panzica F, Avanzini G, Canevini MP, Franceschetti S, Binelli S. Focal epilepsies in adult patients attending two epilepsy centers: Classification of drug-resistance, assessment of risk factors, and usefulness of “new” antiepileptic drugs. Epilepsia 2012; 53:733-40. [DOI: 10.1111/j.1528-1167.2012.03416.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Richardson BD, Brozoski TJ, Ling LL, Caspary DM. Targeting inhibitory neurotransmission in tinnitus. Brain Res 2012; 1485:77-87. [PMID: 22405692 DOI: 10.1016/j.brainres.2012.02.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 02/06/2012] [Accepted: 02/06/2012] [Indexed: 02/07/2023]
Abstract
Tinnitus perception depends on the presence of its neural correlates within the auditory neuraxis and associated structures. Targeting specific circuits and receptors within the central nervous system in an effort to relieve the perception of tinnitus and its impact on one's emotional and mental state has become a focus of tinnitus research. One approach is to upregulate endogenous inhibitory neurotransmitter levels (e.g., glycine and GABA) and selectively target inhibitory receptors in key circuits to normalize tinnitus pathophysiology. Thus, the basic functional and molecular properties of two major ligand-gated inhibitory receptor systems, the GABA(A) receptor (GABA(A)R) and glycine receptor (GlyR) are described. Also reviewed is the rationale for targeting inhibition, which stems from reported tinnitus-related homeostatic plasticity of inhibitory neurotransmitter systems and associated enhanced neuronal excitability throughout most central auditory structures. However, the putative role of the medial geniculate body (MGB) in tinnitus has not been previously addressed, specifically in terms of its inhibitory afferents from inferior colliculus and thalamic reticular nucleus and its GABA(A)R functional heterogeneity. This heterogeneous population of GABA(A)Rs, which may be altered in tinnitus pathology, and its key anatomical position in the auditory CNS make the MGB a compelling structure for tinnitus research. Finally, some selective compounds, which enhance tonic inhibition, have successfully ameliorated tinnitus in animal studies, suggesting that the MGB and, to a lesser degree, the auditory cortex may be their primary locus of action. These pharmacological interventions are examined in terms of their mechanism of action and why these agents may be effective in tinnitus treatment. This article is part of a Special Issue entitled: Tinnitus Neuroscience.
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Affiliation(s)
- Ben D Richardson
- Department of Pharmacology, Southern Illinois University School of Medicine, 801 N Rutledge St, Rm. 3234, PO Box 19629, Springfield, IL 62794, USA.
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Oral toxicity of vigabatrin in immature rats: Characterization of intramyelinic edema. Neurotoxicology 2011; 32:963-74. [DOI: 10.1016/j.neuro.2011.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 11/22/2022]
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Pearl PL, Shukla L, Theodore WH, Jakobs C, Gibson KM. Epilepsy in succinic semialdehyde dehydrogenase deficiency, a disorder of GABA metabolism. Brain Dev 2011; 33:796-805. [PMID: 21664777 PMCID: PMC4385391 DOI: 10.1016/j.braindev.2011.04.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/27/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Succinic semialdehyde dehydrogenase (SSADH) deficiency is a gamma-aminobutyric acid (GABA) degradative defect. Epilepsy affects half of patients. The murine model is associated with a transition from absence to convulsive seizures in the third week, with fatal status epilepticus. METHODS The clinical phenotype is reported from a patient database. Flumazenil-Positron Emission Topography (FMZ-PET) and Transcranial Magnetic Stimulation (TMS) were used to study GABA neurotransmission. Electrocorticography, single cell electrophysiology, and radioligand binding studies are reported from animal studies. RESULTS Generalized seizures predominate, including tonic-clonic, atypical absence, and myoclonic. EEG discharges are typically generalized spike-wave. MRI shows a dentatopallidoluysian pattern. Sudden Unexpected Death in Epilepsy Patients (SUDEP) has occurred and the associated neuropathology reveals chronic excitotoxic injury in gloubus pallidus. Investigations using FMZ-PET and TMS support downregulation of GABA(A) and GABA(B) activity, respectively, in patients. Gamma-hydroxybutyrate (GHB) induces spike-wave discharges in homozygous null mice via GHB and GABA(B)-mediated mechanisms. These resemble absence seizures and are abolished by a GABA(B) receptor antagonist. Decreased binding of GABA(A) and GABA(B) receptor antagonists has been demonstrated in P19 and P14 null mice, respectively. Downregulation of GABA(A) and GABA(B) receptor subunits is observed by P14. GABA(A) and GABA(B) mediated potentials are reduced from P8-P14. CONCLUSION Generalized epilepsy and epileptiform discharges are characteristic of SSADH deficiency. Spontaneous absence seizures appear in null mice by the third week, which may be induced by GHB or GABA(B) activity. Subsequent overuse dependent downregulation of GABA(A) and GABA(B) receptor activity may be associated with hyperexcitability concomitant with the transition to generalized seizures.
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Affiliation(s)
- Phillip L. Pearl
- Department of Neurology, Children’s National Medical Center, George Washington University School of Medicine, Washington, D.C., USA,Clinical Epilepsy Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Lovy Shukla
- Department of Neurology, Children’s National Medical Center, George Washington University School of Medicine, Washington, D.C., USA
| | - William H. Theodore
- Clinical Epilepsy Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Cornelis Jakobs
- Metabolic Unit, Department of Clinical Chemistry, Vrije University Medical Center, Amsterdam, The Netherlands
| | - K. Michael Gibson
- Department of Biological Sciences, Michigan Technological University, Houghton, MI, USA
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Kim KJ, Pearl PL, Jensen K, Snead OC, Malaspina P, Jakobs C, Gibson KM. Succinic semialdehyde dehydrogenase: biochemical-molecular-clinical disease mechanisms, redox regulation, and functional significance. Antioxid Redox Signal 2011; 15:691-718. [PMID: 20973619 PMCID: PMC3125545 DOI: 10.1089/ars.2010.3470] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Succinic semialdehyde dehydrogenase (SSADH; aldehyde dehydrogenase 5a1, ALDH5A1; E.C. 1.2.1.24; OMIM 610045, 271980) deficiency is a rare heritable disorder that disrupts the metabolism of the inhibitory neurotransmitter 4-aminobutyric acid (GABA). Identified in conjunction with increased urinary excretion of the GABA analog gamma-hydroxybutyric acid (GHB), numerous patients have been identified worldwide and the autosomal-recessive disorder has been modeled in mice. The phenotype is one of nonprogressive neurological dysfunction in which seizures may be prominently displayed. The murine model is a reasonable phenocopy of the human disorder, yet the severity of the seizure disorder in the mouse exceeds that observed in SSADH-deficient patients. Abnormalities in GABAergic and GHBergic neurotransmission, documented in patients and mice, form a component of disease pathophysiology, although numerous other disturbances (metabolite accumulations, myelin abnormalities, oxidant stress, neurosteroid depletion, altered bioenergetics, etc.) are also likely to be involved in developing the disease phenotype. Most recently, the demonstration of a redox control system in the SSADH protein active site has provided new insights into the regulation of SSADH by the cellular oxidation/reduction potential. The current review summarizes some 30 years of research on this protein and disease, addressing pathological mechanisms in human and mouse at the protein, metabolic, molecular, and whole-animal level.
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Affiliation(s)
- Kyung-Jin Kim
- Pohang Accelerator Laboratory, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Phillip L. Pearl
- Department of Neurology, Children's National Medical Center, Washington, District of Columbia
| | - Kimmo Jensen
- Synaptic Physiology Laboratory, Department of Physiology and Biophysics, Aarhus University, Aarhus, Denmark
- Center for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
| | - O. Carter Snead
- Department of Neurology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Cornelis Jakobs
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - K. Michael Gibson
- Department of Biological Sciences, Michigan Technological University, Houghton, Michigan
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Moseng L, Sæter M, Mørch-Johnsen GH, Hoff JM, Gajda A, Brodtkorb E, Midelfart A. Retinal nerve fibre layer attenuation: clinical indicator for vigabatrin toxicity. Acta Ophthalmol 2011; 89:452-8. [PMID: 21251242 DOI: 10.1111/j.1755-3768.2010.02077.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate whether persistent visual field defects among patients exposed once to the antiepileptic drug vigabatrin (VGB) were associated with peripapillary retinal nerve fibre layer thickness (RNFLT) attenuation. METHODS Nine individuals with partial epilepsy and VGB-attributed visual field loss (group 1; 18 eyes) and seven age- and gender-matched individuals with epilepsy and no previous VGB exposure (group 2; 14 eyes) were included in the study. Full-field 120 point screening perimetry out to 60 degrees from central fixation using the Humphrey Field Analyzer was performed. RNFLT was quantified by optical coherence tomography (OCT) using Fast RNFLT protocol, Stratus OCT (3.0) after pupillary dilation. The results from the right eye are presented in this article. RESULTS Among the patients with VGB-attributed visual field loss, five patients had only peripheral field defect (group 1a) and the remaining four had advanced field defects both in the periphery and within 30° from central fixation (group 1b). None of the patients in the control group had manifest visual field loss. The mean RNFLT among the patients with VGB-attributed visual field loss was significantly attenuated compared to the controls [mean total RNFLT: group 1: 75.6 ± 12.7 μm, group 2: 103.5 ± 9.7 μm, mean difference 27.9 μm, (CI 15.9-39.9; p < 0.001)]. RNFLT values classified as borderline according to normative database (Stratus OCT) occurred more frequently among individuals with VGB-attributed visual field loss than in controls (frequency in group 1: 6/9; group 2: 0/7, p = 0.011). The nasal, superior and inferior quadrants of RNFLT in individuals with VGB-attributed visual field loss were significantly attenuated, while no difference was detected in temporal quadrants compared to controls. Both individuals with peripheral and those with advanced visual field losses in the VGB group had attenuated mean total RNFLT compared to controls (p = 0.006, p = 0.002, respectively). Occurrence of borderline classification of total RNFLT ≤5th percentile was more frequent among individuals with advanced visual field loss than among controls (p = 0.048). CONCLUSION Persistent visual field loss attributed to VGB is associated with reduced peripapillary RNFLT and was detected both among patients with advanced and among patients with only peripheral visual field defects. Measurements of RNFLT with OCT might be considered as a diagnostic supplement in the follow-up of patients exposed to vigabatrin.
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Affiliation(s)
- Linda Moseng
- Institute of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Besch D, Schiefer U, Eter N, Burth R, Elger CE, Spitznas M, Dietz K. Modelling the topography of absolute defects in patients exposed to the anti-epileptic drug vigabatrin and in normal subjects using automated static suprathreshold perimetry of the entire 80° visual field. Graefes Arch Clin Exp Ophthalmol 2011; 249:1333-43. [PMID: 21380539 DOI: 10.1007/s00417-011-1625-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 12/03/2010] [Accepted: 01/12/2011] [Indexed: 11/25/2022] Open
Abstract
AIM (i) To map the spatial distribution of absolute visual field loss (AL) in patients exposed to vigabatrin and to compare the findings with AL in normal individuals, and (ii) to describe the relationship between the major risk factors for absolute loss (gender, age, cumulative dose), and the severity of field loss, expressed as the number of locations with AL per eye. METHODS Visual field plots were retrospectively reviewed from 428 individuals. Perimetry was done with the Tübingen Automated Perimeter (using a threshold-oriented, marginally supraliminal strategy, 80° eccentricity, 99 test locations). Three hundred and sixty-one individuals were ophthalmologically normal, and 67 were patients exposed to vigabatrin who had performed reliably during perimetry prior to neurosurgery for epilepsy. Two hundred and sixty-six of the 361 normals were included on the empirical basis that they manifested AL at no more than 19 stimulus locations per eye (the 74th percentile). The frequency per eye of AL at each of 99 stimulus locations was determined for the normals and patients. The effects of age, gender and cumulative dose of vigabatrin on the number of ALs per individual was assessed by an analysis of covariance. A stochastic model was developed to determine the 50% probability of AL at each location. RESULTS Thirty-nine of the 67 vigabatrin patients exhibited at least 20 locations with AL. The number of ALs was independent of age (p = 0.7603). The frequency of AL was 14.8% in the peripheral field and 1.0% in the central field (odds ratio 16.7; 95% CI 15.0-18.6%; p < 0.0001). Those exposed to vigabatrin exhibited a frequency of 17.1% ALs, compared to 5.2% for the normal individuals (odds ratio 3.77, 95% CI 3.6-4.0%; p < 0.0001). According to the modelled data, males exhibited 20.9% (95% CI 1.3-44%; p = 0.0360) more absolute losses than did females. The number of absolute losses per person doubled with an increase in cumulative dose of vigabatrin of 936 g (95% CI 775-1181 g). CONCLUSIONS According to this retrospective study, the spatial configuration of absolute defects attributable to vigabatrin indicates sparing of the temporal field up to approximately 60° eccentricity. Such a finding is likely to explain, at least in part, the initially asymptomatic nature of the defect. This study reconfirms a (cumulative) dose effect of vigabatrin on the extent of absolute field loss, with a greater risk for male gender.
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Affiliation(s)
- Dorothea Besch
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany
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Abstract
PURPOSE OF REVIEW Although vigabatrin has been used for many years in Europe, this antiepileptic medication was approved for use in the USA only 1 year ago because of concerns for irreversible peripheral visual field loss that can result in functional visual disability. RECENT FINDINGS Visual function testing involves both subjective and objective techniques, some of which can be standardized across multiple centers. With these subjective and objectives issues as a reference, the current literature about the pathogenesis of vigabatrin visual toxicity is reviewed in order to develop a practical and reliable testing program for detecting peripheral visual field changes early in their course; thereby, hopefully limiting disabling visual field loss. SUMMARY Based upon the existing literature as well as the currently available data about the evaluation of visual function, an algorithm has been developed to serve as a starting point for clinicians to evaluate patients treated with vigabatrin for refractory epilepsy.
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Maguire MJ, Hemming K, Wild JM, Hutton JL, Marson AG. Prevalence of visual field loss following exposure to vigabatrin therapy: A systematic review. Epilepsia 2010; 51:2423-31. [DOI: 10.1111/j.1528-1167.2010.02772.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sorri I, Brigell MG, Mályusz M, Mahlamäki E, de Meynard C, Kälviäinen R. Is reduced ornithine-δ-aminotransferase activity the cause of vigabatrin-associated visual field defects? Epilepsy Res 2010; 92:48-53. [PMID: 20850272 DOI: 10.1016/j.eplepsyres.2010.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 07/24/2010] [Accepted: 08/15/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND A gabaergic antiepileptic drug, vigabatrin (VGB), is known to induce bilateral concentric visual field defects (VFD) in 30-40% of treated patients. Although the clinical and electrophysiological features of VFDs are well documented, the mechanism of retinal toxicity is still unclear. PURPOSE To determine if low basal ornithine-δ-aminotranspherase (OAT) activity is implicated in the etiology of VGB retinotoxicity, resulting in a phenotype of a mild form of gyrate atrophy. METHODS Assays of OAT activity in lymphocytes and GABA-transaminase activity in platelets were performed, and plasma levels of GABA, ornithine, lysine, glutamic acid and glutamine were measured, and visual fields were examined. A total of 47 subjects, aged 14-78 years, were examined. Twenty-one epileptic patients were off VGB more than 1 year; 11 patients with VGB-induced VFD and 10 with normal visual fields. Ten epileptic patients were on current VGB therapy more than 1 year; four patients with VGB-induced VFD and six with normal visual fields. The results were compared with those of 10 epilepsy patients taking tiagabine and six patients who suffered from gyrate atrophy (GA) or were obligate carriers of the disease. RESULTS In patients who had stopped VGB and who had VFDs, OAT activity was significantly reduced as compared with those who had normal visual fields (77.4pmol P5C/min/mgPro vs. 181.9pmol P5C/min/mgPro, p=0.002). In patients with ongoing VGB therapy, no difference was found between the patients with and without VFDs (149.4pmol P5C/min/mgPro vs. 159.1pmol P5C/min/mgPro). CONCLUSIONS : The results suggest that VGB retinotoxicity might be associated with elevated retinal ornithine mediated by low basal OAT activity.
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Affiliation(s)
- Iiris Sorri
- Department of Ophthalmology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland.
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Abstract
Approximately 30 to 40 percent of adults with epilepsy treated chronically with vigabatrin develop concentric visual field constrictions. These deficits are generally mild and asymptomatic, but are usually irreversible, so risks and benefits for vigabatrin treatment must be carefully reviewed. Infantile spasms, a particularly severe form of epilepsy, may respond to vigabatrin; however, some infants treated with the drug develop MRI evidence of possible intramyelinic edema in subcortical structures. This article reviews the benefits of vigabatrin treatment, the risks it poses to the retina and the developing brain, as well as possible subgroups of adults and infants with severe epilepsy for whom treatment may, nevertheless, be warranted.
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Abstract
The newer antiepileptic drugs (AEDs) provide more therapeutic options and overall improved safety and tolerability for patients. To provide the best care, physicians must be familiar with the latest tolerability and safety data. This is particularly true in children, given there are relatively fewer studies examining the effects of AEDs in children compared with adults. Since we now have significant paediatric literature on each of these agents, we provide a comprehensive and current literature review of the newer AEDs, focusing on safety and tolerability data in children and adolescents. Because the safety profiles in children differ from those in adults, familiarity with this literature is important for child neurologists and other paediatric caregivers. We have organized the data by organ system for each AED for easier reference.
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Affiliation(s)
- Dean P Sarco
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital Boston, Boston, Massachusetts, USA.
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Jammoul F, Dégardin J, Pain D, Gondouin P, Simonutti M, Dubus E, Caplette R, Fouquet S, Craft CM, Sahel JA, Picaud S. Taurine deficiency damages photoreceptors and retinal ganglion cells in vigabatrin-treated neonatal rats. Mol Cell Neurosci 2010; 43:414-21. [PMID: 20132888 DOI: 10.1016/j.mcn.2010.01.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 01/22/2010] [Accepted: 01/26/2010] [Indexed: 10/19/2022] Open
Abstract
The anti-epileptic drug vigabatrin induces an irreversible constriction of the visual field, but is still widely used to treat infantile spasms and some forms of epilepsy. We recently reported that vigabatrin-induced cone damage is due to a taurine deficiency. However, optic atrophy and thus retinal ganglion cell degeneration was also reported in children treated for infantile spasms. We here show in neonatal rats treated from postnatal days 4 to 29 that the vigabatrin treatment triggers not only cone photoreceptor damage, disorganisation of the photoreceptor layer and gliosis but also retinal ganglion cell loss. Furthermore, we demonstrate in these neonatal rats that taurine supplementation partially prevents these retinal lesions and in particular the retinal ganglion cell loss. These results provide the first evidence of retinal ganglion cell neuroprotection by taurine. They further confirm that taurine supplementation should be administered with the vigabatrin treatment for infantile spasms or epilepsy.
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Affiliation(s)
- Firas Jammoul
- INSERM, UMR_S968, Institut de la Vision, Paris, France; UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, France
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Sergott RC, Wheless JW, Smith MC, Westall CA, Kardon RH, Arnold A, Foroozan R, Sagar SM. Evidence-based Review of Recommendations for Visual Function Testing in Patients Treated with Vigabatrin. Neuroophthalmology 2010. [DOI: 10.3109/01658100903582498] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Naili F, Boucart M, Derambure P, Arndt C. Visual impairment at large eccentricity in participants treated by vigabatrin: visual, attentional or recognition deficit? Epilepsy Res 2009; 87:213-22. [PMID: 19800764 DOI: 10.1016/j.eplepsyres.2009.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 08/09/2009] [Accepted: 09/04/2009] [Indexed: 12/01/2022]
Abstract
A relationship between peripheral visual field loss and vigabatrin (VGB) has been reported in several studies but with inconsistent results. We investigated the level of visual processing at which the impairment occurs: attentional or cognitive (recognition) deficit. A simple reaction time task was used as a baseline condition. A spatial attention task measured the benefit and cost for the detection of a target appearing at a cued or at an uncued location. A rapid categorization task assessed object recognition. Performance was tested at eccentricities varying from 30 degrees to 60 degrees on a panoramic screen covering 180 degrees. Participants were patients with epilepsy treated with VGB, patients treated with other drugs and healthy controls. In the VGB group 9 patients exhibited a mild visual field constriction. We observed a general slowing down of response times in participants treated by VGB, especially at 60 degrees eccentricity but their performance remained above chance at large eccentricity in the most complex categorization task. The slowing down of visual processing at large eccentricity for flashed stimuli suggests that VGB treated patients might be impaired at detecting moving objects in the periphery and this may have consequences in behavioural tasks like driving.
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Affiliation(s)
- Fatima Naili
- Laboratory of Neurosciences Fonctionnelles & Pathologies, Université Lille Nord de France, CNRS, France
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