与拉莫三嗪和左乙拉西坦联合治疗相关的中毒性视神经病变。
Toxic optic neuropathy associated with lamotrigine and levetiracetam dual therapy.
机构信息
Ophthalmology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Moorfields Eye Hospital NHS Foundation Trust, London, UK.
出版信息
BMJ Case Rep. 2024 Mar 27;17(3):e256961. doi: 10.1136/bcr-2023-256961.
We report the case of an early adolescent male on lamotrigine and levetiracetam therapy with a 1-month history of progressive, bilateral, painless visual loss which resolved on cessation of lamotrigine. To our knowledge, we present the first case of lamotrigine and levetiracetam dual therapy associated with toxic optic neuropathy, supported by electrophysiology and optical coherence tomography (OCT) changes. Electrophysiology findings were consistent with retinal ganglion cell dysfunction, with bilateral optic nerve involvement. Macula OCT showed mild retinal ganglion cell loss in all inner quadrants bilaterally. This case highlights the importance of asking patients with epilepsy treated with lamotrigine and levetiracetam about visual problems and considering early dose reduction or cessation of treatment.
我们报告了一例患有癫痫的早期青少年男性病例，他在使用拉莫三嗪和左乙拉西坦治疗 1 个月后出现双侧进行性、无痛性视力丧失，停药后视力恢复。据我们所知，我们提出了首例拉莫三嗪和左乙拉西坦双重治疗与中毒性视神经病变相关的病例，该病例得到了电生理学和光学相干断层扫描（OCT）改变的支持。电生理学检查结果与视网膜神经节细胞功能障碍一致，双侧视神经受累。黄斑 OCT 显示双侧所有内象限均有轻微的视网膜神经节细胞丢失。该病例强调了询问接受拉莫三嗪和左乙拉西坦治疗的癫痫患者有关视觉问题的重要性，并考虑早期减少剂量或停止治疗。
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