Sabril (Vigabatrin) is an antiepileptic drug with unique efficacy in the treatment of refractory complex partial seizures and infantile spasms. This medication may cause severe adverse reactions, particularly permanent vision damage, so its use must comply with a strict medical supervision system.
Precautions for Using Sabril (Vigabatrin)
Permanent Vision Damage
Sabril can cause irreversible bilateral concentric visual field defects, including tunnel vision, which may lead to functional impairment in severe cases.
In some cases, Sabril may also damage the central retina, resulting in decreased visual acuity.
The characteristics of vision damage include: unpredictable onset time, which may occur within a few weeks after the start of treatment or at any time thereafter.
Patients often find it difficult to detect vision damage on their own before it becomes severe.
The risk of vision damage may persist even after discontinuing the medication.
It is recommended to conduct vision assessments before use (no later than 4 weeks after starting treatment), at least once every 3 months during treatment, and 3 to 6 months after discontinuing the medication.
It should be emphasized that vision monitoring cannot completely prevent the occurrence of vision damage.
Other Systemic Risks
Abnormal brain MRI findings in infants and young children: Some infants treated with Sabril show changes in MRI signals, characterized by increased T2-weighted signals and restricted diffusion, involving the thalamus, basal ganglia, brainstem, and cerebellum.
Neurotoxicity: Animal studies have shown that exposure to Sabril during specific developmental stages may cause neurobehavioral abnormalities and pathological changes in brain tissue.
Risk of suicidal ideation: Similar to other antiepileptic drugs, Sabril may increase the risk of suicidal thoughts or behaviors in patients.
Anemia: Symptoms related to anemia should be closely monitored.
Drowsiness and fatigue: Patients should avoid driving or operating precision machinery until they fully understand the medication's impact on their own abilities.
Peripheral neuropathy: Adult patients may experience symptoms such as numbness and tingling in the extremities.
Monitoring During Sabril (Vigabatrin) Use
Standards for Vision Monitoring
Baseline assessment: To be completed within 4 weeks after starting treatment.
Regular re-evaluation: At least once every 3 months during treatment.
Post-discontinuation follow-up: Assessment to be conducted 3–6 months after discontinuing the medication.
Monitoring methods: Automated threshold perimetry is recommended, supplemented by specialized examinations such as retinal imaging.
Laboratory Index Monitoring
Complete blood count (CBC): Focus on monitoring anemia-related indicators such as hemoglobin and hematocrit.
Liver function monitoring: Sabril may reduce transaminase activity, which may interfere with the detection of early liver injury.
