Severe persistent visual field constriction associated with vigabatrin

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Abstract
Case 1 –A 22 year old woman with longstanding complex partial epilepsy started taking vigabatrin 2000 mg/day in addition to carbamazepine 600 mg/day and sodium valproate 1400 mg/day. Thirty seven months later she complained of tunnel vision and was found to have normal acuity but severely constricted visual fields in both eyes (fig 1 (top)). Her optic discs were slightly pale, and the peripheral retina seemed somewhat atrophic. Magnetic resonance imaging showed left hippocampal atrophy. Blood tests, including mitochondrial DNA screen and measurement of phytanic acid and lysosomal enzyme concentrations, gave normal results. Cone and rod electroretinography showed normal a and b waves, but oscillatory potentials were slightly subnormal. An electro-oculogram showed abnormally low Arden indices (left 139%; right 167%). Visual evoked responses were normal. Fluorescein angiography showed spotty hyperfluorescence in retinal pigment epithelium. Vigabatrin was …

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