Tobimatsu S, Hiromatsu M, Kato M, Goto I
Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Kyushu University.
Rinsho Shinkeigaku. 1992 Jul;32(7):713-7.
Contrast sensitivity function (CSF) was measured in 16 patients (14-60 yr.) with epilepsy to investigate adverse effect of antiepileptic drugs on the central nervous system. Eight patients were treated with phenytoin, while 8 were given polytherapy (phenytoin in combination with phenobarbital, carbamazepine or valproic acid). Thirty-one normal controls (19-59 yr.) were also subjected to this study. Vertical sinusoidal gratings with various spatial frequencies (0.5-20.0 c/deg) were presented on a video monitor. Contrast sensitivity (reciprocal of threshold contrast) was determined at each spatial frequency. CSF of normal subjects showed an inverted U-shaped function against the spatial frequencies with a peak at 6 c/deg (medium size pattern). There was no significant difference in CSF values between normal controls and patients with epilepsy. However, 3 patients with polytherapy showed the significant reduction of contrast threshold. Since these patients did not complain of visual disturbance with normal visual acuity, CSF abnormality was considered as having subclinical visual dysfunction. These results suggest that CSF is useful for evaluating the adverse effect of antiepileptic drugs on the visual recognition, and that polytherapy is responsible for CSF abnormality. Therefore, monotherapy should be scheduled from the onset of therapy.
对16例癫痫患者（年龄14 - 60岁）进行对比敏感度函数（CSF）测量，以研究抗癫痫药物对中枢神经系统的不良反应。8例患者接受苯妥英治疗，8例接受联合治疗（苯妥英与苯巴比妥、卡马西平或丙戊酸联合使用）。31名正常对照者（年龄19 - 59岁）也参与了本研究。在视频监视器上呈现具有各种空间频率（0.5 - 20.0周/度）的垂直正弦光栅。在每个空间频率下测定对比敏感度（阈值对比度的倒数）。正常受试者的CSF相对于空间频率呈现倒U形函数，在6周/度（中等大小图案）处有一个峰值。正常对照者和癫痫患者的CSF值无显著差异。然而，3例接受联合治疗的患者显示对比阈值显著降低。由于这些患者视力正常且未抱怨视觉障碍，CSF异常被认为具有亚临床视觉功能障碍。这些结果表明，CSF可用于评估抗癫痫药物对视觉识别的不良反应，联合治疗是导致CSF异常的原因。因此，应从治疗开始就安排单一疗法。
