喜保宁治疗癫痫的副作用视野缺陷严重吗？

The side effects of Vigabatrin in the treatment of epilepsy are serious visual field defects. During treatment, patients should follow the doctor's advice for regular visual field monitoring. Vigabatrin is a second-generation anti-epileptic drug that is effective in the treatment of infantile spasms and focal seizures, primarily in patients with tuberous sclerosis complex (TSC).

However, reports of adverse events with vigabatrin, including vigabatrin-related visual field loss and brain abnormalities on neuroimaging, have raised concerns about the wider use of vigabatrin, significantly limiting its use.

Vigabatrin side effects: visual field defects

Treatment may cause visual field defects, leading to permanent loss of the patient's vision. This side effect is serious. Because Vigabatrin has certain risks, and once the treatment is effective, it will have obvious clinical effects. Therefore, the patient's efficacy should be frequently evaluated during treatment and the treatment should be continued.

Studies in adults show that more than 30% of patients will experience varying degrees of left and right central visual field narrowing. In severe cases, patients may develop tunnel vision with a visual focus less than 10 degrees, resulting in disability.

In some cases, Vibatrin can also cause damage to the central retina, resulting in vision loss. Vigabatrin-induced blindness is only noticed when the patient or caregiver loses vision completely. Mild visual loss is generally not noticed by patients or caregivers, but it can still have adverse effects on body functions.

Because assessing vision in infants and children can be difficult, the frequency and extent of vision loss in these patients is difficult to describe. Therefore, the understanding of risk is mainly based on the experience of adults. The possibility that Vigabatrin may cause more common and severe visual impairment in infants and young children compared with adults cannot be completely ruled out.

Vigabatrin-induced blindness is unpredictable and may occur within a few weeks of treatment, at any time after treatment, or months or years later.

The risk of vision loss increases with dose and cumulative number of exposures, but it is not yet clear what dose or exposure has no effect on vision.

Prevention and treatment of visual field defects during treatment with Vigabatrin

1. Discontinuation of the drug: For patients with refractory and complex partial epilepsy attacks, if there is no obvious clinical benefit from treatment with Vigabatrin within three months, the drug should be discontinued. If, in the prescriber's clinical judgment, evidence of treatment failure becomes apparent before 3 months, treatment should be discontinued at that time.

2. Vision monitoring: During treatment with Vigabatrin, patients should undergo regular vision monitoring. It is recommended that the vision be monitored by an ophthalmology professional with professional knowledge of visual field interpretation and the ability to perform dilated indirect ophthalmoscopy of the retina. Because visual acuity testing in infants is difficult, vision loss may not be detected until severe. For patients receiving Vigabatrin, it is recommended that visual acuity assessment be performed at baseline (no later than 4 weeks after starting Vigabatrin treatment), at least every 3 months during treatment, and approximately 3-6 months after stopping treatment.

3. Visual field examination: For adult and pediatric patients, it is recommended to conduct visual field examination, preferably through automatic threshold visual field examination. Additional testing may include electrophysiology (eg, electroretinography (ERG)), retinal imaging (eg, optical phase tomography (OCT)), and/or other methods as appropriate for the patient.

For patients who cannot be tested, treatment can be continued based on clinical judgment and appropriate patient counseling. Due to variability, the results of ophthalmic monitoring must be interpreted with caution, and repeat evaluation is recommended if results are abnormal or uninterpretable. Repeated assessments during the first few weeks of treatment are recommended to determine whether and to what extent reproducible results can be obtained and to guide the selection of appropriate ongoing monitoring for the patient.

Efficacy and Safety of Vigabatrin

Background: The efficacy and safety of Vigabatrin as an add-on treatment for refractory epilepsy have been well established. However, this information needs to be weighed against the risk of developing visual field defects. Whether vigabatrin monotherapy is an effective and safe treatment compared with the standard antiepileptic drug carbamazepine (CBZ) monotherapy for the treatment of epilepsy has not been systematically reviewed.

Objective: To compare the efficacy and safety of Vigabatrin and CBZ monotherapy in the treatment of epilepsy in children and adults.

Selection criteria: Randomized controlled trials (RCTs) comparing vigabatrin and CBZ monotherapy in the treatment of epilepsy.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. The primary outcome was time to drug withdrawal. Secondary outcomes were time to 6- and 12-month remission after randomization, time to first seizure after randomization, and adverse events.

Main results: Five studies involving a total of 734 participants met the inclusion criteria. Only one study was rated as high quality and the other four studies were rated as low quality.

There were no significant differences between vigabatrin and CBZ in terms of time to discontinuation and time to 6-month remission after randomized dose stabilization, but the results did show that vigabatrin was at a disadvantage in terms of time to first seizure after randomization.

Vigabatrin was associated with a higher incidence of weight gain and a lower incidence of rash and drowsiness than CBZ. There were no differences in visual field loss and visual impairment.

Author's conclusion: Current data are insufficient to demonstrate the risk-benefit balance of Vigabatrin and CBZ monotherapy in the treatment of epilepsy. Given the high prevalence of visual field defects reported in existing systematic reviews of observational studies, vigabatrin monotherapy should be used with caution in the treatment of epilepsy and should not be considered a first-line option. Visual fields should be assessed frequently if necessary.

Other side effects of Vigabatrin

In addition, Vigabatrin treatment may cause side effects such as neurotoxicity, abnormal magnetic resonance imaging in infants, peripheral neuropathy, drowsiness, fatigue edema, and weight gain. Therefore, patients should use medication carefully under the guidance of a doctor, and consult a doctor promptly if any abnormalities occur and deal with them.

Summary

The onset and progression of vigabatrin-induced vision loss is unpredictable and may occur suddenly or worsen between assessments. Once detected, vision loss due to Vigabatrin is irreversible.

Therefore, the visual field defect caused by Vigabatrin is more serious. Patients need to pay attention during the treatment process and should be monitored regularly under the guidance of a doctor. If vision loss occurs, consider discontinuing the drug as directed by your doctor and balance the benefits and risks.

Recommended hot articles: