Response characteristics of objective perimetry in persons living with epilepsy

• Published in: Journal of the neurological sciences 2022-05, Vol.436, p.120237-120237, Article 120237
• Main Authors: Ali, Eman N., Lueck, Christian J., Carle, Corinne F., Martin, Kate L., Borbelj, Angela, Maddess, Ted
• Format: Article
• Language: English
• Subjects: Epilepsies, Partial - diagnosis; Epilepsies, Partial - drug therapy; Epilepsy - diagnosis; Epilepsy - drug therapy; Focal epilepsy; Generalised epilepsy; Humans; Objective perimetry; Photosensitivity; Pupil - physiology; Pupillary response; Seizures; Visual Field Tests
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2022.120237

To investigate safety and visual-field changes in people with epilepsy undergoing multifocal Pupillographic Objective Perimetry (mfPOP). 15 people with epilepsy and 15 controls underwent mfPOP in the context of routine clinical EEG testing. Safety measures comprised the proportion of participants developing an aura or seizure, a photoparoxysmal response, or increased epileptiform activity on their EEG during mfPOP. Pupil responses were obtained concurrently from 44 regions/field of each eye. Changes in standardised amplitude of constriction and time-to-peak were compared between people with generalised and focal epilepsy, and controls. No participant developed an epileptic aura or clinical seizure during (or after) testing. One participant demonstrated EEG evidence of a focal subclinical seizure which began before mfPOP testing and continued unchanged during testing. Regional field sensitivities were increased in people with generalised epilepsy (+3.80 ± 1.43 dB compared to controls) but were reduced in individuals taking antiepileptic medication (−4.04 ± 1.74 dB). An extra delay of 24.9 ± 10.2 ms was seen in the time-to-peak of the responses in people with focal epilepsy. Based on receiver-operating characteristic analyses, discrimination of people with epilepsy from controls was greatest when using the 4 to 10 most abnormal visual field regions of each eye (%AUC 77.3 ± 9.70). In the absence of any safety signal, mfPOP appears harmless in people with epilepsy. The observed abnormalities in per-region sensitives and delays suggest that mfPOP may provide significant new insights into the study of epilepsy. •The first use of multifocal Pupillographic Objective Perimetry (mfPOP) in epilepsy•Visual field regions with longer delays or increased sensitivities were observed.•Increased sensitivity of pupil response was associated with generalised epilepsy.•Increased delay in pupil response were associated with focal epilepsy.•Concurrent EEG testing showed no safety signal of concern.