London WC1N 3BG & Chalfont Centre for Epilepsy, UCL Queen Square Institute of Neurology, Chalfont St Peter, Buckinghamshire, UK.
Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Epilepsia Open. 2024 Oct;9(5):1783-1792. doi: 10.1002/epi4.13004. Epub 2024 Aug 14.
Using Optical coherence tomography (OCT), we evaluated the association between peripapillary retinal nerve fiber, macular thickness, macular ganglion cell-inner plexiform layer, and drug resistance.
In this cross-sectional study, we recruited people diagnosed with epilepsy and healthy controls. People with epilepsy were further stratified as drug-resistant or non-drug-resistant based on their response to anti-seizure medications. OCT measurements were conducted, and findings in right eye were analyzed.
Fifty-one drug-resistant participants, 37 non-drug-resistant, and 45 controls were enrolled. The average peripapillary retinal nerve fiber layer, ganglion cell-inner plexiform layer, and macular thickness were thinner in the epilepsy groups than in controls. The drug-resistant group had significantly lower average ganglion cell-inner plexiform layer thickness (p = 0.004) and a higher proportion of abnormal/borderline GC/IPL thickness (p = 5.40E-04) than the non-drug-resistant group. Nevertheless, no significant differences were seen between the average thickness of peripapillary retinal nerve fiber and macular thickness. The temporal sectors of these three parameters were also significantly thinner in the drug-resistant group than in the non-drug-resistant. In a multivariate regression model, drug resistance was an independent predictor of reduced ganglion cell-inner plexiform thickness (Odds ratios OR = 10.25, 95% CI 2.82 to 37.28). Increased seizure frequency (r = -0.23, p = 0.039) and a higher number of anti-seizure medications ever used (r = -0.27, p = 0.013) were negatively associated with ganglion cell-inner plexiform layer thickness.
Individuals with drug-resistant epilepsy had a consistent reduction in average ganglion cell-inner plexiform layer thickness and the temporal sector of peripapillary retinal nerve fiber layer and macular thickness. This suggests that ganglion cell-inner plexiform layer thickness could potentially serve as an indicator of the burden of drug resistance, as it correlated with reduced thickness in individuals having more frequent seizures and greater exposure to ASMs.
In our study, we used a special tool called OCT to measure how thick the retina is in people with epilepsy and in healthy control. We found that the retina was consistently thinner in all areas for those with epilepsy compared to healthy control. Particularly, a specific layer called the ganglion cell-inner plexiform layer was a lot thinner in the group that didn't respond to medications, and this thinning was related to how often seizures occurred and how much medications were taken. Also, certain parts of the retina were thinner in the drug-resistant group.
使用光学相干断层扫描（OCT）评估神经纤维层、黄斑厚度、黄斑神经节细胞-内丛状层与耐药性之间的关系。
本横断面研究纳入了癫痫患者和健康对照者。根据抗癫痫药物治疗的反应，将癫痫患者进一步分为耐药组和非耐药组。对右眼进行 OCT 测量并分析右眼中的发现。
共纳入 51 例耐药组、37 例非耐药组和 45 例对照组参与者。与对照组相比，癫痫组的平均神经纤维层、神经节细胞-内丛状层和黄斑厚度更薄。耐药组的平均神经节细胞-内丛状层厚度明显较低（p=0.004），异常/边界神经节细胞-内丛状层厚度比例较高（p=5.40E-04）。然而，神经纤维层和黄斑厚度的平均厚度无显著差异。这三个参数的颞区在耐药组也明显较薄。在多变量回归模型中，耐药性是神经节细胞-内丛状层厚度降低的独立预测因素（优势比 OR=10.25，95%置信区间 2.82 至 37.28）。癫痫发作频率增加（r=-0.23，p=0.039）和使用的抗癫痫药物数量增加（r=-0.27，p=0.013）与神经节细胞-内丛状层厚度呈负相关。
耐药性癫痫患者的平均神经节细胞-内丛状层厚度和神经纤维层的颞区以及黄斑厚度均呈一致性降低。这表明神经节细胞-内丛状层厚度可能是耐药负担的指标，因为它与更频繁的癫痫发作和更多的抗癫痫药物暴露相关。
