This retrospective study aimed to determine the prevalence of ophthalmic abnormalities in children referred to the children’s epilepsy surgery service (CESS) in a single-UK centre and determine associations with epilepsy type and aetiology. This was a review of the CESS from 2015 to 2020 and included 221 children with median age 10.2 ±7.1 years. Median from epilepsy onset to visual assessment was 4.3 ±5.6 years. At least 1 anti-seizure medication was taken by 92%; 71% taking at least 2. Levetiracetam was taken by 43% and vigabatrin by 2%. Coexisting neurodevelopmental disorders were noted in 43%, including learning difficulty, developmental delay, autism and attention deficit hyperactivity disorder (ADHD). Focal epilepsy was diagnosed in 60%, most commonly in temporal and frontal lobes. Structural epilepsy was the most common aetiology; 28% were unknown, 8% genetic, 3% infectious and 1% metabolic. Not all were able to complete all visual assessments due to age and ability. Ophthalmic abnormalities were documented in 53%. There was no significant difference in prevalence of ophthalmic disorders whether with or without associated neurodevelopmental disorders (56% vs 50%). Visual field defects were recorded in 14%, fundus defects in 13% and 22% with abnormalities on optical coherence tomography. Early onset brain injury was associated with higher prevalence of strabismus. There were no other associations found. The authors conclude there is value in an orthoptic-led clinic for children with epilepsy as visual impairment is common. This aids diagnosis and earlier access to management and visual support for home and school.
Findings in an orthoptic-led clinic for children with epilepsy
Reviewed by Fiona Rowe
Prevalence of vision and eye movement abnormalities in children referred to the children’s epilepsy surgery service: a 5-year observation study.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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