New dimension of epilepsy complications: A literature systematic review of visual and retinal disorders

New dimension of epilepsy complications: A literature systematic review of visual and retinal disorders | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article New dimension of epilepsy complications: A literature systematic review of visual and retinal disorders Ahmad Negahi, Mohammad Sattarzadeh, Aref Zarei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3163075/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Epilepsy usually causes irreparable brain damage with its convulsive attacks, depending on whether it is localized or general, damage to the brain nerves is not far away. Aim: This systematic review, we examined the effect of epilepsy on vision complications. Method: This article was written according to PRISMA criteria from January 2018 to January 2022. These articles were selected from PubMed, Scopus and Google scholar (for results follow-up) databases and 98 articles were studied and 11 of them were used in this article. The principle of non-bias was respected and the results were reviewed at the Cochrane Center. Mesh base Keywords: Epilepsy/seizure, optic nerves, oculomotor nerves,Trochlear nerves, Vision disorders, retinal disorders. Results: Epilepsy attacks reduce the thickness of optic nerve ganglions and retinal nerve fibers. Epileptic seizures with damage to retinal nerves and more precisely optic nerve ganglia reduce Retinal Nerve Fiber Layer (RNFL), Ganglion Cell Layer (GCL). Some studies have stated that hypoplasia of the optic nerve, which is a symptom of focal non-convulsive status epilepticus, has been associated with any kinds of epilepsy. Finally, these propositions ended with the reduction of sensitivity to light in several articles, vision response is reduced in patients with persistent epilepsy. Conclusion: visual power decrease and serious retinal nerve damage can be expected from epileptic seizures, that change indicators same as nerve thickness and sensitivity to light. Epilepsy vision disorders retinal disorders Retinal Nerve Fiber Layer (RNFL) Figures Figure 1 Introduction Epilepsy is the most common neurological disorder in children and is characterized by recurrent self-limited seizures, affecting over 65 million people worldwide( 1 ). Seizure is generally classified as generalized or focal. Generalized seizures involve the entire cerebral hemispheres, while focal seizures are localized to a single hemisphere( 2 ). Focal seizures can spread to the other hemisphere( 3 ). Atonic, tonic, myoclonic, and absence seizures are classified as generalized seizures( 4 ), while simple focal, complex focal with sensory and motor symptoms are classified as focal seizures( 5 ). These are primarily diagnosed with Electroencephalography (EEG)( 6 ), but other imaging tools such as computer tomography (CT) and magnetic resonance imaging (MRI) ( 7 ). Epilepsy, whether generalized or focal, can cause irreversible brain damage. Abnormal brain growth and cortical dysplasia in children, hippocampal sclerosis and damage to the cerebellum and temporal lobe are the most likely known causes of damage( 8 – 10 ). Focal seizures have shown the ability to damage the region of their seizure focus, so recent studies have focused on the neuron's disorders associated with focal seizure( 11 , 12 ). systematic reviews and meta-analyses have examined the damage to the temporal lobe( 13 ), amygdala( 14 ) and other points affected by focal seizure, but what was missing among them was a nerve damage in the nerves. Convulsive attacks, whether generalized or focal, are associated with involvement of brain lobes( 15 ). Undoubtedly, the involved lobes affect the target tissue and organs of these nerves by increasing the activity of their outgoing nerves. Nervous fatigue during repeated attacks should be considered along with the damage of nerve terminals resulting from this phenomenon. In multiple sclerosis such vision nerve damage is more evident( 16 ), but in epilepsy, the expectation of such damage to neurons and their function has been somewhat neglected. In this systematic review, unlike previous systematic studies, we examine nerve damage (optic nerves, oculomotor nerves, Trochlear nerves) whose control points are affected by focal seizure focus and have damaged the end organs of these nerves and caused permanent damage. In this systematic review, we will seek to answer the following research question based on the PICO criteria (P = Patient/Problem, I = Intervention, C = Comparison, O = Outcome) Can seizure attacks cause vision damage in patient with epilepsy? Method Articles was studied and validated based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. o STUDY SEARCH In a holistic systematic review, we examined the effect of epilepsy and convulsive attacks on the central nervous system, the results were obtained in the form of three separate systematic articles. To investigation in this study, we searched through PubMed and Scopus to track the results and to verify conflicting articles, we searched the Google Scholar and Cochrane databases. The keywords based on the search results in the Mesh database followed as: Epilepsy/seizure, optic nerves, oculomotor nerves, Trochlear nerves, Vision disorders, retinal disorders. Finally, we started to study the population and embarked on such issues as the pathology, physiology, etiology, treatment, and diagnosis of epilepsy. In case of conflicting results, based on the principle of non-bias, the contradictory ones were mentioned. The type of fundamental study with an analytical writing style. Finally, the results were verified in the Cochrane and Google Scholar databases to verify the accuracy of our analysis. Inclusion criteria and Exclusion criteria Finally, studies published papers from January 2016 to December 2022 were studied. The definition of Epilepsy, Seizure attacks and convulse was written based on the accepted criterion of the international definition of ICD-11 (International Classification of Diseases-11) and was the entry criterion for epilepsy articles. First, we examined the effects of epilepsy on the brain, then we examined the effect of seizure attacks on the brain lobes. Finally, we examined the effect of seizure attacks in epilepsy on the brain nerves. Primarily, duplicated and non-English studies were excluded from the study. Case report and letter to editor studies were also excluded and review articles were used merely to explain and highlight the content as well as the results based on original articles. In the first step, in order to investigate the effect of epilepsy on the brain lobes, we first removed the effects of epilepsy on other parts of the body. In the next step, we categorized the effect of epilepsy on the brain lobes according to the results of previous studies on the origin of 12 pairs of brain nerves. We followed Trochlear, optic and oculomotor nerve to the relevant lobes (cranial lobe) under epilepsy condition. Cerebral nerve damage was examined only in the context of epilepsy and convulsive attacks. studies that were in the field of brain poisoning (drugs or toxic substances), genetic disorders with complex signs and neuropsychic diseases were excluded from the study. Some studies of seizures along with eye injuries as the results of another disease or another syndrome (such as Mowat-Wilson) that not only complicated from epilepsy. were excluded from the study. Data collection Finally, the year of publication, country, study population, kind of epilepsy, intervention and obtained findings, diagnosis structure, other complications and side results. were evaluated by two authors independently; in case of any difference, it was discussed and supervised by the corresponding author. Obtaining content tailored with the answer to the research question based on the PICO criteria mentioned in the introduction, the accuracy of the information was tested by the neurologist author. Results Study selection At first, we searched our keywords in PubMed and Scopus database. We examined 980 articles that base on PRISMA were eligible and were reviewed and if they were not eligible. In the next step, the abstract was studied and we selected only the articles that investigated the effect of epilepsy on brain lobes and nerve damage. Studies that investigated the effect on the optic nerves were selected. The total number of these articles was 457, among which trauma, the effect of drug therapy, genetic cases and neuropsychological cases that were the cause of epilepsy were removed according to the opinion of the neurologist. Finally, 9 articles were able to answer our research question. After writing the results section, we repeated our search in Cochrane and Google Scholar. We observed the principle of non-bias, but we did not come across a conflicting study. In general, the topic of our systematic review did not include many studies, and these few studies followed almost similar results (Fig. 1 ). Population results A total of 2541 individuals were available as patients in the articles, who were suffering from seizures and were examined for eye damage resulting from the attacks. 154 individuals were also under study as controls. The low ratio of control cases was related to past studies that only focused on the patient group. The average age of the control group was 36.72 years, although two articles did not provide complete information. Two studies were in childhood ages and another study had a relatively young average age. In contrast, the control group had an average age of 29.31 years. Except for incomplete studies, 1253 were female and the rest were male. Of the 9 articles available to us, one was unknown and two were in Europe, four in Turkey, and the rest in Asia. All studies were within the last 2 years, which indicates the recent attention of researchers to vision damage in epilepsy (Table 1 ). Table 1 Demographic information extracted from available manuscripts. CASE POPULATION CONTROL POPULATION AGE GEOGRAPHICAL tLOCATION EPILEPCY STATUS STUDY KIND Neslihan Bayraktar Bilen (2021) MAN:18 MAN:16 CASE: 31.36 ± 7.6 (18–44) TURKEY GENERALIZED Case-control FEMALE:10 FEMALE:18 CONTROL: 33.76 ± 6.0 (20–44) Javier Martinez-Poles (2021) MAN:13 MAN:13 CASE:48.4 ± 12.8 SPANISH FOCAL Case-control FEMALE:16 FEMALE:16 CONTROL: 52.5 ± 13.5 Pinar Nalcacioglu(2023) 41 CHILDREN NOT FULL ACCESS 36 CHILDREN NOT FULL ACCESS NOT FULL ACCESS TURKEY EPILEPCY Not specified prospective and cross-sectional Jung-Je Yang (2021) MAN:730 MAN: - 47.4 years (range, 0.4–90.3 years) TERTIARY MEDICAL CENTER EPILEPCY Not specified Retrospective study FEMALE:925 FEMALE: - Matilda Ahl (2021) MAN: MICE MAN: - - - FOCAL NON-CONVULSIVE STATUS EPILECTICUS (FNCSE) - FEMALE: MICE FEMALE: - Fevzi Yılmaz(2023) MAN: Unprovoked seizures 60 MAN: 54 provoked seizures 47.0 (19.0–93.0) Unprovoked seizure 63.5 (18.0–90.0) provoked seizure TURKEY SEIZURE Focal Generalized Non-convulsive Status epilepticus Observational study Prospective FEMALE: 54 Unprovoked seizures FEMALE:42 provoked seizure Monalisa Mohapatra (2022) MAN: 248 MAN: - mean 5.13 ± 9.19 INDIA SEIZURE Not specified Retrospective FEMALE:157 FEMALE: - Weixi Xiong(2021) MAN: 32 HIPOCAMPAL SCLEROSIS 32 EPILEPCY NOT HIPOCAMPAL SCLEROSIS MAN:25 25 HIPOCAMPAL SCLEROSIS 26 EPILEPCY NOT HIPOCAMPAL SCLEROSIS 31 HEALTHY GROUP CHINA EPILEPCY Not specified Retrospective FEMALE: 23 HIPOCAMPAL SCLEROSIS 26 EPILEPCY NOT HIPOCAMPAL SCLEROSIS FEMALE:30 Aysin Tuba Kaplan (2021) 60 PEOPLE NOT FULL ACCESS 8–17 YEASRS NOT FULL ACCESS TURKEY GENERALIZED NOT FULL ACCESS TOTAL = 9 articles CASES: 2541 CONTROL :154 The population of each study was entered separately by case and control groups, also by gender. If each of the mentioned groups included other divisions, mentioned in the relevant section specifically. Main results The retina is directly connected to the brain nerves that exit from the lobes, and in addition to being able to image it, the diameter of the axons that belong to the brain nerves can be measured with optical coherence tomography ( 17 ). Neslihan Bayraktar Bilen observed in her results that the diameter of these axons, called the retinal nerve fiber layer (RNFL), is significantly less in patients with epilepsy than in healthy individuals. Even after starting epilepsy treatment, this ratio was maintained according to the study of Aysin Tuba Kaplan, was less than the newly diagnosed group. Neslihan Bayraktar Bilen also did not observe a significant difference between single-drug and multi-drug treatment groups. It seems that after RNFL decreases in epileptic patients, it cannot be expected that epilepsy treatment will restore the reduced diameter. The decrease in RNFL was attributed to the type of epilepsy, as Weixi Xiong expected that if epilepsy resulted from a brain injury (patients with Hippocampal sclerosis (HS)), the retina would lose a larger diameter of its nerve fibers. However, HS is a resistant factor in epilepsy that is strongly associated with a decrease in RNFL severity. It is noteworthy that the involvement side in the brain and the decrease in RNFL in the retina are the same, and it may be concluded that non-disseminated focal seizures will also have a greater impact on visual acuity. This point may be important in managing injuries resulting from focal seizures. Along with RNFL, central macular thickness (CMT) follows a similar pattern, but it seems that effective drug therapy (multi-drug treatment in Neslihan Bayraktar Bilen's study) can partially restore the lost thickness. The ganglion cell complex did not differ between treatment groups in this study, but it also had a decrease in thickness in epileptic patients. This decrease in complex thickness may justify the thickness of the subfoveal choroid, which is rich in retinal ganglion cells (Table 2 ). Table 2 All terms are mentioned at least once in complete shape in the table. First author / year published / Doi number Aim Diagnosis Results Highlights Support results Neslihan Bayraktar Bilen (2021) DOI: 10.1177/1120672119881982 Assessed optical coherence tomography (17) findings in epileptic patients and compared it to healthy controls. optical coherence tomography (17) • ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL)thickness in all regions were found to be decreased in epilepsy group compared to healthy controls • The smallest difference between the two groups was in the thickness of the Temporal part, and the largest difference was seen in the Superior and Inferior part • Ganglion cell complex and retinal nerve fiber layer thickness measurements were not significantly different between polytherapy and monotherapy groups. • Optical coherence tomography may be a useful tool for showing the neurodegeneration in patients with epilepsy Javier Martinez-Poles (2021) DOI: 10.1007/s00062-020-00969-0 Assessed epilepsy associated with temporal pole Encephaloceles (ETPE) could be the consequence and an unrecognized manifestation of idiopathic intracranial hypertension (IIH). Magnetic Resonance Imaging (MRI) • Left and right optic nerve sheaths (ONS) diameters were also significantly larger in the TPE group than in the control group. • The TPE group patients had lower pituitary gland height (PGH) • larger diameter of ONS than controls being similar to validated data of IIH • No patient with TPE had clinical manifestations of elevated Intracranial pressure (ICP) Pinar Nalcacioglu(2023) DOI: 10.1016/j.pdpdt.2023.103582 Assessed the vascular changes of the optic nerve head (43) and macula by using optical coherence tomography angiography (OCT-A), and also the choroidal vascular structure Image binarization tool from Enhanced depth imaging (EDI) OCT scans • significant decrease in the vessel density (VD) of the choriocapillaris (CC) and the CC flow area in children with epilepsy compared to healthy subjects • the VD of the radial peripapillary capillary (RPC), and of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the macula were similar between the two groups • The sub foveal choroidal thickness (SFCT) •, choroidal area, luminal area, and Cortical Visual Impairment (44) were statistically significant lower in children with newly diagnosed epilepsy compared to healthy subjects choroidal perfusion from the microcirculation is lower in children with newly diagnosed epilepsy. Jung-Je Yang (2021) Doi: 10.3390/jpm11101022 we aimed to investigate the real-world applications and diagnostic value of full-field Electroretinography (ffERG) during the past eight years Electroretinography (ERG) • the majority of patients received ffERG because of neurological disease involving the central nervous system, including cerebrovascular disease, brain tumors, epilepsy, Parkinson’s disease, and Wilson disease. • Higher rates were found in patients < 20 years old in the 'systemic diseases' and 'optic neuropathies' groups; epilepsy and optic nerve atrophy were the most common diagnoses, respectively. ffERG is indispensable for diagnosis and prognosis in ophthalmologic and multidisciplinary practice. Matilda Ahl (2021) DOI: 10.1016/j.eplepsyres.2021.106730 Assessed hippocampal focal non-convulsive status epilepticus(fNCSE)-induced retinal pathology ex vivo in mice. high-resolution 7 T structural T1-weighted magnetic resonance imaging (MRI) and 9.4 T diffusion tensor imaging (DTI) • Seven weeks post-fNCSE, increased number of Iba1 + microglia were evident in the retina ipsilateral to the hemisphere with fNCSE, and morphologically more activated microglia were found in both ipsi- and contralateral retina compared to non-stimulated control mice. • T1-weighted intensity measurements of the contralateral retina showed a minor increase within the outer nuclear and plexiform layers of the lateral retina. • No changes were observed in the distal part of the optic nerve • retinal pathology after fNCSE in mice is subtle and present bilaterally. • The sensitivity of both imaging techniques for identifying larger retinal alteration was confirmed ex vivo in retinitis pigmentosa mice where a substantial neurodegeneration of the outer retinal layers is evident Fevzi Yılmaz(2023) DOI: 10.5144/0256-4947.2023.42 Assess the efficacy of bedside ONSD measurement in differentiating provoked seizure from un-provoked seizure. bedside ocular ultrasonography • ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group • The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure Bedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure. Monalisa Mohapatra (2022) Doi: 10.4103/ijo.IJO_801_22 Assessed the causes, associated neurological and ocular findings in children with cerebral visual impairment (44), and to identify risk factors for severe vision impairment. Visual acuity assessment Significant refractive error by diopters measure Optic atrophy was diagnosed by the pallor of the optic nerve head • common causes of CVI were hypoxic-ischemic encephalopathy, seizure associated with brain damage • The most common neurological finding was seizure, followed by cerebral palsy CVI were hypoxic-ischemic encephalopathy, seizure associated with brain damage, neonatal hypoglycemia, structural neurological malformations, and infection Weixi Xiong(2021) Doi: 10.3389/fneur.2021.663559 Assessed the likelihood and characteristic of RNFL loss in individuals with epilepsy having Hippocampal sclerosis (HS). MRI AND OCT • The average papillary RNFL (pRNFL) ipsilateral to the side of HS was significantly thinner than people with epilepsy non-HS and healthy controls, especially in the inferior quadrants. • Average pRNFL Thickness Between HS and Epilepsy Groups One of 55 participants in people with HS group and one of 58 in epilepsy non-HS had abnormal overall average pRNFL thinning with 11 further individuals. one and ten had significant or borderline abnormal thinning of the pRNFL of the ipsilateral eye to the HS. These preliminary findings suggest that retinal abnormalities associated with HS may have a specific pattern. Aysin Tuba Kaplan (2021) DOI: 10.1177/11206721211049710 retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and sub foveal choroid thickness (CT) optical coherence tomography (17) • Nasal quadrant RNFL thickness and CMT measurements were significantly lower in the monotherapy group compared with the newly diagnosed group • CT measurements were not significantly different between the groups • There was a negative correlation in regression analysis between the duration of drug use and RNFL thickness in all quadrants. Contrary to the thickness of the ganglion cells in the retina, the thickness of the optic nerve sheath related to epilepsy showed a significant increase. Fevzi Yılmaz measured the thickness of the optic nerve sheath diameter (ONSD) in stimulated and non-stimulated seizures, which was larger than that of healthy individuals. Stimulated seizures showed a greater thickness compared to non-stimulated ones. Matilda Ahl's study found that ganglion cells are more active in epileptic seizures and there is a slight increase in the outer nucleus of the nerves leading to the retina. However, this study was conducted on mice with non-convulsive epilepsy, but a noticeable decrease in retinal thickness was still observed. An increase in nerve thickness may be due to increased activity in the lobes involved in epilepsy, as patients with temporal lobe epilepsy (ETPE), which is the main sign of epilepsy, showed higher ONSD in studies. This increase in diameter in nerves can be attributed to inflammation of ganglion cells. Studies that were excluded from our statistical population showed inflammation caused by epilepsy, but inflammation resulting from increased neuronal activity in epilepsy is a subject of high ambiguity and requires further studies (Table 2 ). In a study by Pinar Nalcacioglu, it was revealed that children with epilepsy experience a decrease in macular perfusion. The choriocapillaris (CC)vessel density (VD) was found to be reduced, which may suggest the presence of vascular inflammation. However, this contradicts the expected increase in blood flow during inflammation, and further studies are necessary to clarify this. Other studies have also shown a decrease in radial peripapillary capillary, subfoveal choroidal thickness, superficial capillary plexus, and deep capillary plexus in children with epilepsy (Table 2 ). Discussion Visual disturbance can be considered as one of the side effects of epilepsy, in which myelin of nerves, nerve thickness and diameter of the main retina are the main factors affected by seizures. The results of previous studies have shown that epilepsy and seizures impair vision( 18 , 19 ), and this issue was not accompanied by conflicting results (according to the principle of non-bias). The main organ that may be affected in the pathway of visual impairment is the retina and the nerves that end in it. This issue was observed in stable seizures, drug-resistant seizures, generalized seizures, focal seizures and multi-focal seizures. The thickness of nerves ending in the retina was reduced and optic neuropathies such as visual, Neuromyelitis Optica Spectrum Disorder (NMOSD)( 20 ) and optic neuritis were affected by seizure attacks( 21 ). Visual acuity and contrast sensitivity are reduced under the influence of these attacks( 22 ), which deprive individuals of normal vision both in children and adults. What we needed to answer our research question was direct nerve damage, but the greatest role in these cases was played by the conditions of epilepsy and seizure: optic nerve hypoplasia( 23 ), choroidal thickness, retinal nerve fiber layer (RNFL), optic nerve atrophy( 24 ), peripapillary retinal nerve fiber layer (PPRNFL). The main tool introduced in the studies was optical coherence tomography ( 17 ), which seems to be a useful tool for measuring the function of eye nerves (base our results). However, diagnostic tools such as spectral-domain optical coherence tomography( 25 ), Enhanced depth imaging (EDI), Electroretinography and bedside ocular ultrasonography also maintained their place. These tools were less used in previous studies for monitoring the accuracy of diagnostic tools. However, it seems that they may have been considered for accurately determining the health of brain nerves (especially those ending in the eye) and benefiting from them. The importance of using precise diagnostic tools becomes more apparent when epilepsy causes damage to the lobes of the brain and these damages will affect the health of the eyes. In general, if multi-focal seizures are not controlled, visual impairment may be the least of our concerns. Generalized seizures often affected the retina nerves and perfusion( 25 , 26 ), so that the thickness of ganglion cells in these patients was significantly lower than in healthy individuals. Treatment with seizure-controlling drugs had somewhat improved this decrease in visual acuity and ganglion cell damage, but it seems that inflammation of ganglion cells that damage nerves should also be considered( 27 , 28 ). These results did not directly indicate damage to the Oculomotor and Trochlear nerves, but rather suggested a decrease in visual acuity and contrast. It may be inferred from this that the overall function of the eye is influenced by all the nerves that end in it, and this decrease in visual acuity and contrast is a comprehensive reflection of damage to all the nerves involved in eye function. In order to make a decision about the exact impact of epilepsy and seizure, specialized studies on each of these nerves should be conducted. However, newer studies suggest that there is a gap in this area and more specialized research is needed on this subject. The available articles mostly published their results in the past 2 years, indicating that investigating the damage to the eye and vision caused by epilepsy is a recent issue that has been addressed. Most issues related to the relationship between epilepsy and brain and eye damage are still unclear. Generalized seizures, drug-resistant seizures and controllable seizures can all cause damage to different lobes of the brain( 29 – 31 ). Temporal lobe epilepsy (TLE) is associated with impairment in alertness, impaired memory, executive function and sleep-wake disorders( 32 – 34 ). The least likely damage in TLE may be to the visual nerves, as they are anatomically distant from the visual cortex. However, Javier Martinez-Poles found that patients with temporal pole Encephalosclerosis (ETPE) (a syndrome whose main manifestation is seizures) had a larger diameter of the visual sheath that could from inflammation( 35 ). The frontal lobes are usually targeted after the temporal lobes( 36 ). Speech and nonverbal disorders, short-term and long-term auditory-verbal memory and learning disorders, motor function and vision are all worsened in frontal lobe epilepsy( 37 , 38 ). The greatest impact on vision may be seen in occipital lobe seizures, attributing most disorders to the eye movement section( 39 ). Eye movement sensation, initial forced blinking or shaking of the eyelids and lack of visual field are often the result of occipital lobe epilepsy( 40 – 42 ). As a result, different lobes can affect vision, with multiple lobes (multifocal seizures) having a greater impact, with each lobe affecting its own visual and ocular nerves. Although only nerves ending in the eye are part of the effect of seizures on central nervous system (CNS) nerves. Many studies have not been conducted on seizures and nerve damage caused by them, and this limited amount of research has received attention in recent years. In summary, our results show that epilepsy threatens the health of the retina, optic nerves and eye health. In the management of the complications of epilepsy, attention is paid to the damage of the brain nerves, especially the optic nerves. In order to diagnose and manage these injuries, OCT can be introduced as a useful tool, but if we accept that a person suffering from epilepsy may lose their vision. Conclusion visual power decrease and serious retinal nerve damage can be expected from epileptic seizures, that change indicators same as nerve thickness and sensitivity to light. We suggest that visual health should be taken into consideration in the management of epilepsy treatment and control of its side effects. We also recommend that clinical studies be conducted on the effect of epilepsy on the damage of ganglia and brain nerves, because there are many ambiguities in this field. Declarations Ethics approval and consent to participate All procedures performed in this systematic review involving human participants studies, were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The present study is a research project that held under neurology department of Hormozgan university medical science supervision. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests The authors declare no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions Dr. Ahmad Negahi Conceived and designed the analysis, MR. Mohammad Satarzadeh contributes data and wrote manuscript. Eventually, Mr. Aref Zarei Edited manuscript and All authors reviewed that. Acknowledgment We would like to thank the Department of Neurology at Bandar Abbas University of Medical Sciences for their assistance in this study and for their efforts in verifying our results. References Kanner AM, Bicchi MM. Antiseizure Medications for Adults With Epilepsy: A Review. Jama. 2022;327(13):1269-81. Agashe S, Worrell G, Britton J, Noe K, Ritaccio A, Wirrell EC, et al. Cenobamate in Generalized Epilepsy and Combined Generalized and Focal Epilepsy. Neurol Clin Pract. 2023;13(2):e200133. Kumar A, Maini K, Arya K, Sharma S. Simple Partial Seizure. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023. Beniczky S, Rubboli G, Covanis A, Sperling MR. 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The Expanding MEGDEL Phenotype: Optic Nerve Atrophy, Microcephaly, and Myoclonic Epilepsy in a Child with SERAC1 Mutations. JIMD Rep. 2014;16:75-9. Nalcacioglu P, Mehmet I, Gultutan P, Yilmaz D, Kurt ANC. Ocular perfusion characteristics of children with newly diagnosed epilepsy. Photodiagnosis and Photodynamic Therapy. 2023;42:103582. D’Agnano D, Lo Cascio S, Correnti E, Raieli V, Sciruicchio V. A Narrative Review of Visual Hallucinations in Migraine and Epilepsy: Similarities and Differences in Children and Adolescents. Brain Sciences. 2023;13(4):643. Chong D, Jones NC, Schittenhelm RB, Anderson A, Casillas-Espinosa PM. Multi-omics Integration and Epilepsy: Towards a Better Understanding of Biological Mechanisms. Progress in Neurobiology. 2023:102480. Zhuo Z, Wang Y, Kong H, Fu T. GKLF, a transcriptional activator of Txnip, drives microglia activation in kainic acid-induced murine models of epileptic seizures. International Immunopharmacology. 2023;121:110426. Zhou C, Fang S, Yang J, Wang Y, Wang L. Epilepsy-related white matter network changes in patients with frontal lobe glioma. Journal of Neuroradiology. 2023;50(2):258-65. Peltola M, Basnyat P, Liimatainen S, Rainesalo S, Pesu M, Peltola J. The Regulation of Plasma Interleukin-6 Levels Is Modified by Hippocampal Sclerosis and Its Lateralization in Drug-Resistant Temporal Lobe Epilepsy. Acta Neurologica Scandinavica. 2023;2023. Fisher RS. Deep brain stimulation of thalamus for epilepsy. Neurobiology of Disease. 2023:106045. Sekeres MJ, Riggs L, Decker A, de Medeiros CB, Bacopulos A, Skocic J, et al. Impaired Recent, but Preserved Remote, Autobiographical Memory in Pediatric Brain Tumor Patients. J Neurosci. 2018;38(38):8251-61. Englot DJ, D'Haese PF, Konrad PE, Jacobs ML, Gore JC, Abou-Khalil BW, et al. Functional connectivity disturbances of the ascending reticular activating system in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry. 2017;88(11):925-32. Law N, Smith ML, Widjaja E. Thalamocortical Connections and Executive Function in Pediatric Temporal and Frontal Lobe Epilepsy. AJNR Am J Neuroradiol. 2018;39(8):1523-9. Martinez-Poles J, Toledano R, Jiménez-Huete A, García-Morales I, Aledo-Serrano Á, Anciones C, et al. Epilepsy Associated with Temporal Pole Encephaloceles : An Unrecognized Manifestation of Idiopathic Intracranial Hypertension? Clin Neuroradiol. 2021;31(3):575-9. Barot N. Networks in Frontal Lobe Epilepsy. Neurosurg Clin N Am. 2020;31(3):319-24. Sezikli S, Pulat TA, Tekin B, Ak PD, Keskinkılıç C, Ataklı D. Frontal lobe cognitive functions and electroencephalographic features in juvenile myoclonic epilepsy. Epilepsy Behav. 2018;86:102-7. Patrikelis P, Giovagnoli AR, Messinis L, Fasilis T, Malefaki S, Verentzioti A, et al. Understanding frontal lobe function in epilepsy: Juvenile myoclonic epilepsy vs. frontal lobe epilepsy. Epilepsy Behav. 2022;134:108850. Maillard L, Ferrand M, Aron O, Cheval M, Tyvaert L, Jonas J, et al. Visual phenomena and anatomo-electro-clinical correlations in occipital lobe seizures. Rev Neurol (Paris). 2022;178(7):644-8. Heo W, Kim JS, Chung CK, Lee SK. Relationship between cortical resection and visual function after occipital lobe epilepsy surgery. J Neurosurg. 2018;129(2):524-32. Brinciotti M, Mittica A, Matricardi M. Characteristics of visual evoked potentials related to the electro-clinical expression of reflex seizures in photosensitive patients with idiopathic occipital lobe epilepsy. Epilepsy Res. 2020;164:106345. Castejón O. Electroclinical Study of Neonate, Infant and Young Epileptic Patients. EC Emergency Medicine and Critical Care. 2023;7:28-40. Thirupathi A, Scarparo S, Silva PL, Marqueze LF, Vasconcelos FTF, Nagashima S, et al. Physical Exercise-Mediated Changes in Redox Profile Contribute to Muscle Remodeling After Passive Hand-Rolled Cornhusk Cigarette Smoke Exposure. Front Physiol. 2020;11:590962. Sesar AP, Sesar A, Bucan K, Sesar I, Cvitkovic K, Cavar I. Personality Traits, Stress, and Emotional Intelligence Associated with Central Serous Chorioretinopathy. Med Sci Monit. 2021;27:e928677. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3163075","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":224320131,"identity":"098ccd70-cc6a-48db-9f6a-8fd7a19466b9","order_by":0,"name":"Ahmad Negahi","email":"","orcid":"","institution":"Hormozgan University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Negahi","suffix":""},{"id":224320132,"identity":"4560c25b-b212-42f9-9e6a-fbaeeaa883f8","order_by":1,"name":"Mohammad Sattarzadeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYHCDBDbmPxU2QAZj4wGCig9AtTDwnEkDaWkgQQtv22EkARxAt4H94ecPNffs+duTjz2QOHPebm37YaAtNTbRuLSYHeAxljhwrJhZ4syzdAODitvJ284kArUcS8ttwK2FQeIAG9BRN3LMJBLO3E42OwDUwthwGI8W9sc/DvxL4JG/kf9N4mDbuWSz8w8JaWEwA6pMkDC4kcMm2dh2wM7sBiFbDvOYWZztSzAwPPPMTJrhTHKC2Q2gLQn4/HK8/fGNim8J9nLHk59JM1TY2ZudT3/44EONDU4tDMxo/ESwygRcyrEBe1IUj4JRMApGwcgAAHbEZ1ZjwpdFAAAAAElFTkSuQmCC","orcid":"","institution":"Hormozgan University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Sattarzadeh","suffix":""},{"id":224320133,"identity":"102d7c65-390a-4dc5-88ff-b50a2c85cb63","order_by":2,"name":"Aref Zarei","email":"","orcid":"","institution":"Hormozgan University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aref","middleName":"","lastName":"Zarei","suffix":""}],"badges":[],"createdAt":"2023-07-12 09:14:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3163075/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3163075/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":41379260,"identity":"f6947620-5d4a-4a5b-93d9-80910b1dead7","added_by":"auto","created_at":"2023-08-10 15:12:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34900,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of study selection process, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3163075/v1/6737bf7bed97ab05765bccb8.png"},{"id":50985813,"identity":"49c39ed8-899c-4426-9a55-91541e7ec546","added_by":"auto","created_at":"2024-02-12 07:56:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":336420,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3163075/v1/1ff625e7-d9d4-4dd0-ae09-9af93b7b3a04.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"New dimension of epilepsy complications: A literature systematic review of visual and retinal disorders","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEpilepsy is the most common neurological disorder in children and is characterized by recurrent self-limited seizures, affecting over 65\u0026nbsp;million people worldwide(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Seizure is generally classified as generalized or focal. Generalized seizures involve the entire cerebral hemispheres, while focal seizures are localized to a single hemisphere(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Focal seizures can spread to the other hemisphere(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Atonic, tonic, myoclonic, and absence seizures are classified as generalized seizures(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), while simple focal, complex focal with sensory and motor symptoms are classified as focal seizures(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). These are primarily diagnosed with Electroencephalography (EEG)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), but other imaging tools such as computer tomography (CT) and magnetic resonance imaging (MRI) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEpilepsy, whether generalized or focal, can cause irreversible brain damage. Abnormal brain growth and cortical dysplasia in children, hippocampal sclerosis and damage to the cerebellum and temporal lobe are the most likely known causes of damage(\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Focal seizures have shown the ability to damage the region of their seizure focus, so recent studies have focused on the neuron's disorders associated with focal seizure(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). systematic reviews and meta-analyses have examined the damage to the temporal lobe(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), amygdala(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and other points affected by focal seizure, but what was missing among them was a nerve damage in the nerves. Convulsive attacks, whether generalized or focal, are associated with involvement of brain lobes(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Undoubtedly, the involved lobes affect the target tissue and organs of these nerves by increasing the activity of their outgoing nerves. Nervous fatigue during repeated attacks should be considered along with the damage of nerve terminals resulting from this phenomenon. In multiple sclerosis such vision nerve damage is more evident(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), but in epilepsy, the expectation of such damage to neurons and their function has been somewhat neglected.\u003c/p\u003e \u003cp\u003eIn this systematic review, unlike previous systematic studies, we examine nerve damage (optic nerves, oculomotor nerves, Trochlear nerves) whose control points are affected by focal seizure focus and have damaged the end organs of these nerves and caused permanent damage. In this systematic review, we will seek to answer the following research question based on the PICO criteria (P\u0026thinsp;=\u0026thinsp;Patient/Problem, I\u0026thinsp;=\u0026thinsp;Intervention, C\u0026thinsp;=\u0026thinsp;Comparison, O\u0026thinsp;=\u0026thinsp;Outcome)\u003c/p\u003e \u003cp\u003eCan seizure attacks cause vision damage in patient with epilepsy?\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eArticles was studied and validated based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eo STUDY SEARCH\u003c/h2\u003e \u003cp\u003eIn a holistic systematic review, we examined the effect of epilepsy and convulsive attacks on the central nervous system, the results were obtained in the form of three separate systematic articles. To investigation in this study, we searched through PubMed and Scopus to track the results and to verify conflicting articles, we searched the Google Scholar and Cochrane databases. The keywords based on the search results in the Mesh database followed as:\u003c/p\u003e \u003cp\u003eEpilepsy/seizure, optic nerves, oculomotor nerves, Trochlear nerves, Vision disorders, retinal disorders.\u003c/p\u003e \u003cp\u003eFinally, we started to study the population and embarked on such issues as the pathology, physiology, etiology, treatment, and diagnosis of epilepsy. In case of conflicting results, based on the principle of non-bias, the contradictory ones were mentioned. The type of fundamental study with an analytical writing style. Finally, the results were verified in the Cochrane and Google Scholar databases to verify the accuracy of our analysis.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eInclusion criteria and Exclusion criteria\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eFinally, studies published papers from January 2016 to December 2022 were studied. The definition of Epilepsy, Seizure attacks and convulse was written based on the accepted criterion of the international definition of ICD-11 (International Classification of Diseases-11) and was the entry criterion for epilepsy articles. First, we examined the effects of epilepsy on the brain, then we examined the effect of seizure attacks on the brain lobes. Finally, we examined the effect of seizure attacks in epilepsy on the brain nerves.\u003c/p\u003e \u003cp\u003ePrimarily, duplicated and non-English studies were excluded from the study. Case report and letter to editor studies were also excluded and review articles were used merely to explain and highlight the content as well as the results based on original articles. In the first step, in order to investigate the effect of epilepsy on the brain lobes, we first removed the effects of epilepsy on other parts of the body. In the next step, we categorized the effect of epilepsy on the brain lobes according to the results of previous studies on the origin of 12 pairs of brain nerves. We followed Trochlear, optic and oculomotor nerve to the relevant lobes (cranial lobe) under epilepsy condition. Cerebral nerve damage was examined only in the context of epilepsy and convulsive attacks. studies that were in the field of brain poisoning (drugs or toxic substances), genetic disorders with complex signs and neuropsychic diseases were excluded from the study. Some studies of seizures along with eye injuries as the results of another disease or another syndrome (such as Mowat-Wilson) that not only complicated from epilepsy. were excluded from the study.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eData collection\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eFinally, the year of publication, country, study population, kind of epilepsy, intervention and obtained findings, diagnosis structure, other complications and side results. were evaluated by two authors independently; in case of any difference, it was discussed and supervised by the corresponding author. Obtaining content tailored with the answer to the research question based on the PICO criteria mentioned in the introduction, the accuracy of the information was tested by the neurologist author.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudy selection\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAt first, we searched our keywords in PubMed and Scopus database. We examined 980 articles that base on PRISMA were eligible and were reviewed and if they were not eligible. In the next step, the abstract was studied and we selected only the articles that investigated the effect of epilepsy on brain lobes and nerve damage. Studies that investigated the effect on the optic nerves were selected. The total number of these articles was 457, among which trauma, the effect of drug therapy, genetic cases and neuropsychological cases that were the cause of epilepsy were removed according to the opinion of the neurologist. Finally, 9 articles were able to answer our research question. After writing the \u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003eresults\u003c/span\u003e section, we repeated our search in Cochrane and Google Scholar. We observed the principle of non-bias, but we did not come across a conflicting study. In general, the topic of our systematic review did not include many studies, and these few studies followed almost similar results (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePopulation results\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003eA total of 2541 individuals were available as patients in the articles, who were suffering from seizures and were examined for eye damage resulting from the attacks. 154 individuals were also under study as controls. The low ratio of control cases was related to past studies that only focused on the patient group. The average age of the control group was 36.72 years, although two articles did not provide complete information. Two studies were in childhood ages and another study had a relatively young average age. In contrast, the control group had an average age of 29.31 years. Except for incomplete studies, 1253 were female and the rest were male. Of the 9 articles available to us, one was unknown and two were in Europe, four in Turkey, and the rest in Asia. All studies were within the last 2 years, which indicates the recent attention of researchers to vision damage in epilepsy (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information extracted from available manuscripts.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCASE POPULATION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCONTROL POPULATION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAGE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGEOGRAPHICAL tLOCATION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEPILEPCY STATUS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSTUDY KIND\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNeslihan Bayraktar Bilen (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAN:18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAN:16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCASE: 31.36\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6 (18\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTURKEY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGENERALIZED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCase-control\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEMALE:10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFEMALE:18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCONTROL: 33.76\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0 (20\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eJavier Martinez-Poles (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAN:13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAN:13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCASE:48.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSPANISH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFOCAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCase-control\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEMALE:16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFEMALE:16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCONTROL: 52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePinar Nalcacioglu(2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 CHILDREN\u003c/p\u003e \u003cp\u003eNOT FULL ACCESS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 CHILDREN\u003c/p\u003e \u003cp\u003eNOT FULL ACCESS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNOT FULL ACCESS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTURKEY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEPILEPCY\u003c/p\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eprospective and cross-sectional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eJung-Je Yang (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAN:730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAN: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e47.4 years (range, 0.4\u0026ndash;90.3 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTERTIARY MEDICAL CENTER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEPILEPCY\u003c/p\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEMALE:925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFEMALE: -\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMatilda Ahl (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAN: MICE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAN: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFOCAL NON-CONVULSIVE STATUS EPILECTICUS (FNCSE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEMALE: MICE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFEMALE: -\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFevzi Yılmaz(2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAN: Unprovoked seizures 60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAN: 54 provoked seizures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e47.0 (19.0\u0026ndash;93.0)\u003c/p\u003e \u003cp\u003eUnprovoked seizure\u003c/p\u003e \u003cp\u003e63.5 (18.0\u0026ndash;90.0) provoked seizure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTURKEY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSEIZURE\u003c/p\u003e \u003cp\u003eFocal\u003c/p\u003e \u003cp\u003eGeneralized\u003c/p\u003e \u003cp\u003eNon-convulsive Status epilepticus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eObservational study\u003c/p\u003e \u003cp\u003eProspective\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEMALE: 54 Unprovoked seizures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFEMALE:42\u003c/p\u003e \u003cp\u003eprovoked seizure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMonalisa Mohapatra (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAN: 248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAN: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003emean 5.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eINDIA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSEIZURE\u003c/p\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEMALE:157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFEMALE: -\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWeixi Xiong(2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAN:\u003c/p\u003e \u003cp\u003e32 HIPOCAMPAL SCLEROSIS\u003c/p\u003e \u003cp\u003e32 EPILEPCY NOT HIPOCAMPAL SCLEROSIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAN:25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25 HIPOCAMPAL SCLEROSIS\u003c/p\u003e \u003cp\u003e26 EPILEPCY NOT HIPOCAMPAL SCLEROSIS\u003c/p\u003e \u003cp\u003e31 HEALTHY GROUP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCHINA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEPILEPCY\u003c/p\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEMALE:\u003c/p\u003e \u003cp\u003e23 HIPOCAMPAL SCLEROSIS\u003c/p\u003e \u003cp\u003e26 EPILEPCY NOT HIPOCAMPAL SCLEROSIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFEMALE:30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAysin Tuba Kaplan (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e60 PEOPLE\u003c/p\u003e \u003cp\u003eNOT FULL ACCESS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u0026ndash;17 YEASRS\u003c/p\u003e \u003cp\u003eNOT FULL ACCESS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTURKEY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGENERALIZED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNOT FULL ACCESS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTOTAL\u0026thinsp;=\u0026thinsp;9 articles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eCASES: 2541\u003c/p\u003e \u003cp\u003eCONTROL :154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eThe population of each study was entered separately by case and control groups, also by gender. If each of the mentioned groups included other divisions, mentioned in the relevant section specifically.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eMain results\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe retina is directly connected to the brain nerves that exit from the lobes, and in addition to being able to image it, the diameter of the axons that belong to the brain nerves can be measured with optical coherence tomography (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Neslihan Bayraktar Bilen observed in her results that the diameter of these axons, called the retinal nerve fiber layer (RNFL), is significantly less in patients with epilepsy than in healthy individuals. Even after starting epilepsy treatment, this ratio was maintained according to the study of Aysin Tuba Kaplan, was less than the newly diagnosed group. Neslihan Bayraktar Bilen also did not observe a significant difference between single-drug and multi-drug treatment groups. It seems that after RNFL decreases in epileptic patients, it cannot be expected that epilepsy treatment will restore the reduced diameter. The decrease in RNFL was attributed to the type of epilepsy, as Weixi Xiong expected that if epilepsy resulted from a brain injury (patients with Hippocampal sclerosis (HS)), the retina would lose a larger diameter of its nerve fibers. However, HS is a resistant factor in epilepsy that is strongly associated with a decrease in RNFL severity. It is noteworthy that the involvement side in the brain and the decrease in RNFL in the retina are the same, and it may be concluded that non-disseminated focal seizures will also have a greater impact on visual acuity. This point may be important in managing injuries resulting from focal seizures. Along with RNFL, central macular thickness (CMT) follows a similar pattern, but it seems that effective drug therapy (multi-drug treatment in Neslihan Bayraktar Bilen's study) can partially restore the lost thickness. The ganglion cell complex did not differ between treatment groups in this study, but it also had a decrease in thickness in epileptic patients. This decrease in complex thickness may justify the thickness of the subfoveal choroid, which is rich in retinal ganglion cells (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAll terms are mentioned at least once in complete shape in the table.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst author / year published / Doi number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAim\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResults Highlights\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSupport results\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeslihan Bayraktar Bilen (2021)\u003c/p\u003e \u003cp\u003eDOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1120672119881982\u003c/span\u003e\u003cspan address=\"10.1177/1120672119881982\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessed optical coherence tomography (17) findings in epileptic patients and compared it to healthy controls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eoptical coherence tomography (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL)thickness in all regions were found to be decreased in epilepsy group compared to healthy controls\u003c/p\u003e \u003cp\u003e\u0026bull; The smallest difference between the two groups was in the thickness of the Temporal part, and the largest difference was seen in the Superior and Inferior part\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Ganglion cell complex and retinal nerve fiber layer thickness measurements were not significantly different between polytherapy and monotherapy groups.\u003c/p\u003e \u003cp\u003e\u0026bull; Optical coherence tomography may be a useful tool for showing the neurodegeneration in patients with epilepsy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJavier Martinez-Poles (2021)\u003c/p\u003e \u003cp\u003eDOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00062-020-00969-0\u003c/span\u003e\u003cspan address=\"10.1007/s00062-020-00969-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessed epilepsy associated with temporal pole Encephaloceles (ETPE) could be the consequence\u003c/p\u003e \u003cp\u003eand an unrecognized manifestation of idiopathic intracranial hypertension (IIH).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMagnetic Resonance Imaging (MRI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Left and right optic nerve sheaths (ONS) diameters were also significantly larger in the TPE group than in the control group.\u003c/p\u003e \u003cp\u003e\u0026bull; The TPE group patients had lower pituitary gland height (PGH)\u003c/p\u003e \u003cp\u003e\u0026bull; larger diameter of ONS than controls being similar to validated data of IIH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; No patient with TPE had clinical manifestations of elevated Intracranial pressure (ICP)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePinar Nalcacioglu(2023)\u003c/p\u003e \u003cp\u003eDOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pdpdt.2023.103582\u003c/span\u003e\u003cspan address=\"10.1016/j.pdpdt.2023.103582\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessed the vascular changes of the optic nerve head (43) and macula by using optical coherence tomography angiography (OCT-A), and also the choroidal vascular structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImage binarization tool from Enhanced depth imaging (EDI) OCT scans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; significant decrease in the vessel density (VD) of the choriocapillaris (CC) and the CC flow area in children with epilepsy compared to healthy subjects\u003c/p\u003e \u003cp\u003e\u0026bull; the VD of the radial peripapillary capillary (RPC), and of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the macula were similar between the two groups\u003c/p\u003e \u003cp\u003e\u0026bull; The sub foveal choroidal thickness (SFCT)\u003c/p\u003e \u003cp\u003e\u0026bull;, choroidal area, luminal area, and Cortical Visual Impairment (44) were statistically significant lower in children with newly diagnosed epilepsy compared to healthy subjects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003echoroidal perfusion from the microcirculation is lower in children with newly diagnosed epilepsy.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJung-Je Yang (2021)\u003c/p\u003e \u003cp\u003eDoi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jpm11101022\u003c/span\u003e\u003cspan address=\"10.3390/jpm11101022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ewe aimed to investigate the real-world applications and diagnostic value of full-field Electroretinography (ffERG) during the past eight years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eElectroretinography (ERG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; the majority of patients received ffERG because of neurological disease involving the central nervous system, including cerebrovascular disease, brain tumors, epilepsy, Parkinson\u0026rsquo;s disease, and Wilson disease.\u003c/p\u003e \u003cp\u003e\u0026bull; Higher rates were found in patients\u0026thinsp;\u0026lt;\u0026thinsp;20 years old in the 'systemic diseases' and 'optic neuropathies' groups; epilepsy and optic nerve atrophy were the most common diagnoses, respectively.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003effERG is indispensable for diagnosis and prognosis in ophthalmologic and multidisciplinary practice.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMatilda Ahl (2021)\u003c/p\u003e \u003cp\u003eDOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.eplepsyres.2021.106730\u003c/span\u003e\u003cspan address=\"10.1016/j.eplepsyres.2021.106730\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessed hippocampal focal non-convulsive status epilepticus(fNCSE)-induced retinal pathology ex vivo in mice.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ehigh-resolution 7 T structural T1-weighted magnetic resonance imaging (MRI) and 9.4 T diffusion tensor imaging (DTI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Seven weeks post-fNCSE, increased number of Iba1\u0026thinsp;+\u0026thinsp;microglia were evident in the retina ipsilateral to the hemisphere with fNCSE, and morphologically more activated microglia were found in both ipsi- and contralateral retina compared to non-stimulated control mice.\u003c/p\u003e \u003cp\u003e\u0026bull; T1-weighted intensity measurements of the contralateral retina showed a minor increase within the outer nuclear and plexiform layers of the lateral retina.\u003c/p\u003e \u003cp\u003e\u0026bull; No changes were observed in the distal part of the optic nerve\u003c/p\u003e \u003cp\u003e\u0026bull; retinal pathology after fNCSE in mice is subtle and present bilaterally.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; The sensitivity of both imaging techniques for identifying larger retinal alteration was confirmed ex vivo in retinitis pigmentosa mice where a substantial neurodegeneration of the outer retinal layers is evident\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFevzi Yılmaz(2023)\u003c/p\u003e \u003cp\u003eDOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5144/0256-4947.2023.42\u003c/span\u003e\u003cspan address=\"10.5144/0256-4947.2023.42\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssess the efficacy of bedside ONSD measurement in differentiating provoked seizure from un-provoked seizure.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ebedside ocular ultrasonography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group\u003c/p\u003e \u003cp\u003e\u0026bull; The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonalisa Mohapatra (2022)\u003c/p\u003e \u003cp\u003eDoi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijo.IJO_801_22\u003c/span\u003e\u003cspan address=\"10.4103/ijo.IJO_801_22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessed the causes, associated neurological and ocular findings in children with cerebral visual impairment (44), and to identify risk factors for severe vision impairment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVisual acuity assessment\u003c/p\u003e \u003cp\u003eSignificant refractive error by diopters measure\u003c/p\u003e \u003cp\u003eOptic atrophy was diagnosed by the pallor of the optic nerve head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; common causes of CVI were hypoxic-ischemic encephalopathy, seizure associated with brain damage\u003c/p\u003e \u003cp\u003e\u0026bull; The most common neurological finding was seizure, followed by cerebral palsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVI were hypoxic-ischemic encephalopathy, seizure associated with brain damage, neonatal hypoglycemia, structural neurological malformations, and infection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeixi Xiong(2021)\u003c/p\u003e \u003cp\u003eDoi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fneur.2021.663559\u003c/span\u003e\u003cspan address=\"10.3389/fneur.2021.663559\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessed the likelihood and characteristic of RNFL loss in individuals with epilepsy having Hippocampal sclerosis (HS).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMRI AND OCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; The average papillary RNFL (pRNFL) ipsilateral to the side of HS was significantly thinner than people with epilepsy non-HS and healthy controls, especially in the inferior quadrants.\u003c/p\u003e \u003cp\u003e\u0026bull; Average pRNFL Thickness Between HS and Epilepsy Groups One of 55 participants in people with HS group and one of 58 in epilepsy non-HS had abnormal overall average pRNFL thinning with 11 further individuals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eone and ten had significant or borderline abnormal thinning of the pRNFL of the ipsilateral eye to the HS.\u003c/p\u003e \u003cp\u003eThese preliminary findings suggest that retinal abnormalities associated with HS may have a specific pattern.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAysin Tuba Kaplan (2021)\u003c/p\u003e \u003cp\u003eDOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/11206721211049710\u003c/span\u003e\u003cspan address=\"10.1177/11206721211049710\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eretinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and sub foveal choroid thickness (CT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eoptical coherence tomography (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Nasal quadrant RNFL thickness and CMT measurements were significantly lower in the monotherapy group compared with the newly diagnosed group\u003c/p\u003e \u003cp\u003e\u0026bull; CT measurements were not significantly different between the groups\u003c/p\u003e \u003cp\u003e\u0026bull; There was a negative correlation in regression analysis between the duration of drug use and RNFL thickness in all quadrants.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eContrary to the thickness of the ganglion cells in the retina, the thickness of the optic nerve sheath related to epilepsy showed a significant increase. Fevzi Yılmaz measured the thickness of the optic nerve sheath diameter (ONSD) in stimulated and non-stimulated seizures, which was larger than that of healthy individuals. Stimulated seizures showed a greater thickness compared to non-stimulated ones. Matilda Ahl's study found that ganglion cells are more active in epileptic seizures and there is a slight increase in the outer nucleus of the nerves leading to the retina. However, this study was conducted on mice with non-convulsive epilepsy, but a noticeable decrease in retinal thickness was still observed. An increase in nerve thickness may be due to increased activity in the lobes involved in epilepsy, as patients with temporal lobe epilepsy (ETPE), which is the main sign of epilepsy, showed higher ONSD in studies. This increase in diameter in nerves can be attributed to inflammation of ganglion cells. Studies that were excluded from our statistical population showed inflammation caused by epilepsy, but inflammation resulting from increased neuronal activity in epilepsy is a subject of high ambiguity and requires further studies (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a study by Pinar Nalcacioglu, it was revealed that children with epilepsy experience a decrease in macular perfusion. The choriocapillaris (CC)vessel density (VD) was found to be reduced, which may suggest the presence of vascular inflammation. However, this contradicts the expected increase in blood flow during inflammation, and further studies are necessary to clarify this. Other studies have also shown a decrease in radial peripapillary capillary, subfoveal choroidal thickness, superficial capillary plexus, and deep capillary plexus in children with epilepsy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eVisual disturbance can be considered as one of the side effects of epilepsy, in which myelin of nerves, nerve thickness and diameter of the main retina are the main factors affected by seizures. The results of previous studies have shown that epilepsy and seizures impair vision(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and this issue was not accompanied by conflicting results (according to the principle of non-bias). The main organ that may be affected in the pathway of visual impairment is the retina and the nerves that end in it. This issue was observed in stable seizures, drug-resistant seizures, generalized seizures, focal seizures and multi-focal seizures. The thickness of nerves ending in the retina was reduced and optic neuropathies such as visual, Neuromyelitis Optica Spectrum Disorder (NMOSD)(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and optic neuritis were affected by seizure attacks(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Visual acuity and contrast sensitivity are reduced under the influence of these attacks(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), which deprive individuals of normal vision both in children and adults. What we needed to answer our research question was direct nerve damage, but the greatest role in these cases was played by the conditions of epilepsy and seizure: optic nerve hypoplasia(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), choroidal thickness, retinal nerve fiber layer (RNFL), optic nerve atrophy(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), peripapillary retinal nerve fiber layer (PPRNFL). The main tool introduced in the studies was optical coherence tomography (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), which seems to be a useful tool for measuring the function of eye nerves (base our results). However, diagnostic tools such as spectral-domain optical coherence tomography(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), Enhanced depth imaging (EDI), Electroretinography and bedside ocular ultrasonography also maintained their place. These tools were less used in previous studies for monitoring the accuracy of diagnostic tools. However, it seems that they may have been considered for accurately determining the health of brain nerves (especially those ending in the eye) and benefiting from them. The importance of using precise diagnostic tools becomes more apparent when epilepsy causes damage to the lobes of the brain and these damages will affect the health of the eyes.\u003c/p\u003e \u003cp\u003eIn general, if multi-focal seizures are not controlled, visual impairment may be the least of our concerns. Generalized seizures often affected the retina nerves and perfusion(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), so that the thickness of ganglion cells in these patients was significantly lower than in healthy individuals. Treatment with seizure-controlling drugs had somewhat improved this decrease in visual acuity and ganglion cell damage, but it seems that inflammation of ganglion cells that damage nerves should also be considered(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). These results did not directly indicate damage to the Oculomotor and Trochlear nerves, but rather suggested a decrease in visual acuity and contrast. It may be inferred from this that the overall function of the eye is influenced by all the nerves that end in it, and this decrease in visual acuity and contrast is a comprehensive reflection of damage to all the nerves involved in eye function. In order to make a decision about the exact impact of epilepsy and seizure, specialized studies on each of these nerves should be conducted. However, newer studies suggest that there is a gap in this area and more specialized research is needed on this subject. The available articles mostly published their results in the past 2 years, indicating that investigating the damage to the eye and vision caused by epilepsy is a recent issue that has been addressed. Most issues related to the relationship between epilepsy and brain and eye damage are still unclear.\u003c/p\u003e \u003cp\u003eGeneralized seizures, drug-resistant seizures and controllable seizures can all cause damage to different lobes of the brain(\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Temporal lobe epilepsy (TLE) is associated with impairment in alertness, impaired memory, executive function and sleep-wake disorders(\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The least likely damage in TLE may be to the visual nerves, as they are anatomically distant from the visual cortex. However, Javier Martinez-Poles found that patients with temporal pole Encephalosclerosis (ETPE) (a syndrome whose main manifestation is seizures) had a larger diameter of the visual sheath that could from inflammation(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The frontal lobes are usually targeted after the temporal lobes(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Speech and nonverbal disorders, short-term and long-term auditory-verbal memory and learning disorders, motor function and vision are all worsened in frontal lobe epilepsy(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The greatest impact on vision may be seen in occipital lobe seizures, attributing most disorders to the eye movement section(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Eye movement sensation, initial forced blinking or shaking of the eyelids and lack of visual field are often the result of occipital lobe epilepsy(\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). As a result, different lobes can affect vision, with multiple lobes (multifocal seizures) having a greater impact, with each lobe affecting its own visual and ocular nerves. Although only nerves ending in the eye are part of the effect of seizures on central nervous system (CNS) nerves. Many studies have not been conducted on seizures and nerve damage caused by them, and this limited amount of research has received attention in recent years.\u003c/p\u003e \u003cp\u003eIn summary, our results show that epilepsy threatens the health of the retina, optic nerves and eye health. In the management of the complications of epilepsy, attention is paid to the damage of the brain nerves, especially the optic nerves. In order to diagnose and manage these injuries, OCT can be introduced as a useful tool, but if we accept that a person suffering from epilepsy may lose their vision.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003evisual power decrease and serious retinal nerve damage can be expected from epileptic seizures, that change indicators same as nerve thickness and sensitivity to light. We suggest that visual health should be taken into consideration in the management of epilepsy treatment and control of its side effects. We also recommend that clinical studies be conducted on the effect of epilepsy on the damage of ganglia and brain nerves, because there are many ambiguities in this field.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eAll procedures performed in this systematic review involving human participants studies, were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The present study is a research project that held under neurology department of Hormozgan university medical science supervision.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eDr. Ahmad Negahi Conceived and designed the analysis, MR. Mohammad Satarzadeh contributes data and wrote manuscript. Eventually, Mr. Aref Zarei Edited manuscript and All authors reviewed that.\u003c/p\u003e\n\u003cp\u003eAcknowledgment\u003c/p\u003e\n\u003cp\u003eWe would like to thank the Department of Neurology at Bandar Abbas University of Medical Sciences for their assistance in this study and for their efforts in verifying our results. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKanner AM, Bicchi MM. Antiseizure Medications for Adults With Epilepsy: A Review. Jama. 2022;327(13):1269-81.\u003c/li\u003e\n\u003cli\u003eAgashe S, Worrell G, Britton J, Noe K, Ritaccio A, Wirrell EC, et al. Cenobamate in Generalized Epilepsy and Combined Generalized and Focal Epilepsy. Neurol Clin Pract. 2023;13(2):e200133.\u003c/li\u003e\n\u003cli\u003eKumar A, Maini K, Arya K, Sharma S. Simple Partial Seizure. StatPearls. 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Med Sci Monit. 2021;27:e928677.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Epilepsy, vision disorders, retinal disorders, Retinal Nerve Fiber Layer (RNFL)","lastPublishedDoi":"10.21203/rs.3.rs-3163075/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3163075/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEpilepsy usually causes irreparable brain damage with its convulsive attacks, depending on whether it is localized or general, damage to the brain nerves is not far away.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic review, we examined the effect of epilepsy on vision complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article was written according to PRISMA criteria from January 2018 to January 2022. These articles were selected from PubMed, Scopus and Google scholar (for results follow-up) databases and 98 articles were studied and 11 of them were used in this article. The principle of non-bias was respected and the results were reviewed at the Cochrane Center.\u003c/p\u003e\n\u003cp\u003eMesh base Keywords: Epilepsy/seizure, optic nerves, oculomotor nerves,Trochlear nerves, Vision disorders, retinal disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEpilepsy attacks reduce the thickness of optic nerve ganglions and retinal nerve fibers. Epileptic seizures with damage to retinal nerves and more precisely optic nerve ganglia reduce Retinal Nerve Fiber Layer (RNFL), Ganglion Cell Layer (GCL). Some studies have stated that hypoplasia of the optic nerve, which is a symptom of focal non-convulsive status epilepticus, has been associated with any kinds of epilepsy. Finally, these propositions ended with the reduction of sensitivity to light in several articles, vision response is reduced in patients with persistent epilepsy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003evisual power decrease and serious retinal nerve damage can be expected from epileptic seizures, that change indicators same as nerve thickness and sensitivity to light.\u003c/p\u003e","manuscriptTitle":"New dimension of epilepsy complications: A literature systematic review of visual and retinal disorders","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-10 15:11:56","doi":"10.21203/rs.3.rs-3163075/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"315f14df-836f-4dfe-b328-f25696258cba","owner":[],"postedDate":"August 10th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-12T07:48:45+00:00","versionOfRecord":[],"versionCreatedAt":"2023-08-10 15:11:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3163075","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3163075","identity":"rs-3163075","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}