Vigabatrin Effects on Visual Function and Imaging
Summary
Vigabatrin is an antiepileptic agent that irreversibly inhibits γ-aminobutyric acid transaminase, thereby elevating central GABA levels and suppressing seizure activity. Despite its efficacy in infantile spasms and refractory focal seizures, vigabatrin is uniquely associated with peripheral visual field constriction and retinal toxicity. Clinical assessment of vigabatrin-related ocular effects employs visual field perimetry, electroretinography and optical coherence tomography (OCT) to detect functional and structural changes in the retina and optic nerve. Imaging studies demonstrate thinning of the peripapillary retinal nerve fibre layer and macular layers, correlating with the severity and duration of exposure. Preclinical work indicates preferential accumulation of the active enantiomer in the retina and visual cortex, with light exposure and phototransduction pathways contributing to toxicity. Emerging evidence examines genetic susceptibility to retinal nerve fibre layer thinning and explores whether rare variants underlie individual risk. The global challenge lies in balancing seizure control against potential visual impairment. Optimised monitoring protocols, personalised dosing strategies and refinements in imaging biomarkers aim to mitigate ocular risk while preserving therapeutic benefit.
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Vigabatrin Effects on Visual Function and Imaging publication trend
The graph below shows the total number of articles in vigabatrin effects on visual function and imaging across all publications each year (not limited to Nature Index journals).
Technical terms
Peripapillary retinal nerve fibre layer (ppRNFL): The annular band of nerve fibres surrounding the optic disc, measured by OCT to assess optic nerve health.
Optical coherence tomography (OCT): A non-invasive imaging modality that generates high-resolution cross-sectional images of retinal layers.
Electroretinogram (ERG): An electrophysiological test recording retinal electrical responses to light stimuli, indicating photoreceptor and inner retinal function.
Visual field perimetry: A functional assessment mapping the extent and sensitivity of a patient’s peripheral vision.
GABA transaminase: The enzyme responsible for GABA degradation; its inhibition by vigabatrin leads to increased inhibitory neurotransmission.
References
- Testing for pharmacogenomic predictors of ppRNFL thinning in individuals exposed to vigabatrin. Frontiers in Neuroscience (2023).
- Ocular examinations, findings, and toxicity in children taking vigabatrin. Journal of American Association for Pediatric Ophthalmology and Strabismus (2022).
- Peripheral visual field defect of vigabatrin in pediatric epilepsy: A review. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery (2023).
- Preclinical tissue distribution and metabolic correlations of vigabatrin, an antiepileptic drug associated with potential use‐limiting visual field defects. Pharmacology Research & Perspectives (2019).
- Vigabatrin-Induced Retinal Toxicity Is Partially Mediated by Signaling in Rod and Cone Photoreceptors. PLOS ONE (2012).
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