Microstructural Damage to the Optic Nerve with Vigabatrin Treatment in West Syndrome: A DTI Study

Objective: This study aimed to assess the side effects of vigabatrin (VGB), focusing on optic nerve fiber damage in children with West syndrome, using DTI imaging parameters. Method: Clinical data and DTI images were analyzed, recording FA and ADC values for both optic nerves. ROC curves were used to determine fractional anisotropy thresholds for optic nerve damage. Results: Thirty-five children with West syndrome (0.3-22 months old, male: female = 19:16) were divided into three groups: (1) VGB and other anti-seizure medications (ASMs) with symmetrical thalamus abnormalities, (2) VGB and ASMs without thalamus abnormalities, and (3) control group with other ASMs. FA values in group 1 were significantly lower than in group 3 (P < 0.05), and FA values increased after VGB discontinuation (P < 0.05). The ROC analysis showed a cut-off score of 304 with 63.6% sensitivity and 100% specificity for detecting optic nerve damage. Conclusion: FA values are effective imaging markers for detecting VGB-induced optic nerve damage in West syndrome, especially when thalamus abnormalities are present. FA values significantly improve after stopping VGB treatment.