Paul S R, Krauss G L, Miller N R, Medura M T, Miller T A, Johnson M A
Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Epilepsia. 2001 Apr;42(4):525-30. doi: 10.1046/j.1528-1157.2001.49299.x.
Vigabatrin (VGB) has been shown to cause visual field constriction and other forms of mild visual dysfunction. We determined the safety of continuing VGB therapy in patients who had received prolonged treatment (>2 years) with the drug by serially monitoring changes in visual function over a 1-year period of continued therapy. We also followed up patients who discontinued VGB to see whether alternative therapies are effective.
Fifteen of 17 patients who continued VGB therapy had visual-function testing (visual acuity, color vision, kinetic and static perimetry) every 3 months for 1 year. Eighteen patients who discontinued VGB were given alternative antiepileptic drugs (AEDs); their seizure responses were measured after > or =3 months of treatment.
Patients continuing VGB showed no worsening of visual acuity, color vision, or visual-field constriction beyond that measured in the initial test. Many patients who discontinued VGB had good seizure control with either newer or previously unsuccessful AEDs.
For patients who have an excellent response to VGB and only mild visual changes, continued therapy may be safe with close visual monitoring. Patients who do not have a significant reduction in seizures or who experience considerable visual dysfunction with VGB may respond well to alternative therapies.
已证明vigabatrin（VGB）可导致视野缩小及其他形式的轻度视觉功能障碍。我们通过在持续治疗的1年期间连续监测视觉功能变化，确定了在接受该药物长期治疗（>2年）的患者中继续使用VGB治疗的安全性。我们还对停用VGB的患者进行了随访，以观察替代疗法是否有效。
继续使用VGB治疗的17例患者中有15例在1年时间里每3个月进行一次视觉功能测试（视力、色觉、动态和静态视野检查）。18例停用VGB的患者给予替代抗癫痫药物（AEDs）；在治疗≥3个月后测量他们的癫痫发作反应。
继续使用VGB的患者在视力、色觉或视野缩小方面并未出现超过初始测试所测情况的恶化。许多停用VGB的患者使用新型或之前无效的AEDs后癫痫得到了良好控制。
对于对VGB反应良好且仅有轻度视觉变化的患者，在密切视觉监测下继续治疗可能是安全的。癫痫发作未显著减少或使用VGB出现相当程度视觉功能障碍的患者可能对替代疗法反应良好。
