Visual contrast sensitivity in carbamazepine-resistant epileptic patients receiving vigabatrin as add-on therapy

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In 40 adult patients with partial epilepsy resistant to carbamazepine (CBZ) monotherapy at the maximum tolerated individual doses, vigabatrin (VGB) was added to reduce seizure frequency further. In an attempt to evaluate potential drug-related visual side effects, visual contrast sensitivity (VCS), i.e., the ability to perceive minimal differences in luminance between adjacent regions of a grating visual pattern, was assessed before and monthly during a 6-month period of VGB add-on therapy and compared with that of a control group of healthy subjects. Twenty-eight patients completed the prescribed 6-month period of trial and were included in the statistical analysis. VCS measured during CBZ treatment showed a clear loss in all explored spatial frequencies. From the second month of VGB treatment on, VCS exhibited a progressive recovery, especially in the medium-frequency range, although only to a partial extent as compared with that in the controls. This effect saturated at the sixth month. Moreover, a different recovery of VCS to vertical and oblique gratings was observed, which likely suggests a drug effect on visual cortex. VGB add-on therapy was both well tolerated and effective in reducing seizure frequency.

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