Abstract

Objective: This study aimed to evaluate peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell–inner plexiform layer (GCL+IPL) thickness in children with epilepsy using optical coherence tomography (OCT), and to compare these parameters with healthy controls. Additionally, the relationship between retinal structure and epilepsy duration, as well as antiseizure medication (ASM) exposure (notably valproate), was investigated.

Material and Methods: Fifty pediatric epilepsy patients and 50 healthy children aged between 6 and 18 years underwent spectral-domain OCT (Zeiss Cirrus HD-OCT 5000) to measure RNFL, GCL+IPL, and central subfield thickness (CST). Independent-samples t-test and Spearman correlation analysis were used to assess group differences and associations with clinical variables. Retinal thickness values were also compared across ASM subgroups (valproate, levetiracetam, carbamazepine, lamotrigine monotherapy, and polytherapy).

Results: Compared to controls, children with epilepsy had significantly thinner average RNFL (95.0±11.0 μm vs 101.0±9.0 μm; p = 0.020) and superior quadrant RNFL (125±15 μm vs 132±14 μm; p = 0.030). GCL+IPL thickness was also significantly reduced in the epilepsy group (80.0±5.5 μm vs 85.0±5.0 μm; p = 0.003), as was CST (240±22 μm vs 250±20 μm; p = 0.045). Longer epilepsy duration correlated negatively with RNFL (ρ = –0.300; p = 0.030) and GCL+IPL (ρ = –0.35; p = 0.010). While retinal thickness did not differ significantly across ASM subgroups, the valproate and polytherapy groups had numerically lower values.

Conclusion: Pediatric epilepsy is associated with subtle but significant thinning of RNFL and inner macular layers, suggesting subclinical neurodegenerative effects. The observed correlation with disease duration indicates a possible progressive impact. Although differences between ASM groups were not statistically significant, valproate may contribute to retinal changes. OCT appears to be a valuable noninvasive tool for assessing neuroaxonal integrity in pediatric epilepsy.

Keywords: Epilepsy, optical coherence tomography, pediatrics, retina, valproate

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Copyright © 2025 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Güneş A, Güneş K. Retinal OCT changes in pediatric epilepsy: neurodegeneration and antiseizure medication effects. Turk J Pediatr Dis. 2025;Early View:1-5. https://doi.org/10.12956/TJPD.2025.1128