癫痫患者视网膜神经轴突缺失情况下的视敏度。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy Pub Date : 2024-11-14 DOI:10.1016/j.seizure.2024.10.019

Luisa Delazer , Joachim Havla , Soheyl Noachtar , Elisabeth Kaufmann

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引用次数: 0

摘要

目的：最近的研究报告显示，癫痫患者（PWE）视网膜神经轴突明显缺失。然而，这些结构改变对视觉功能（即视力）的影响尚不清楚：在这项前瞻性队列研究中，年龄均在 18-55 岁之间的 70 名癫痫患者和 76 名健康对照者（HC）接受了 100 % 高对比度（HCVA）和 2.5 % 低对比度（LCVA）斯隆字母图视力评估。用光谱域光学相干断层扫描（OCT）评估了全周视网膜神经纤维层（G-pRNFL）的厚度和神经节细胞内丛状层（GCIP）的体积。为了进行统计分析，癫痫组被细分为服用钠通道阻滞药物（SCB）的癫痫患者（n = 52）和未服用钠通道阻滞药物的癫痫患者（n = 18），因为之前已有报道称钠离子通道阻滞药物会影响视觉感知：结果：与 HC（101.31 ± 8.28 µm，p = .01；2.10 ± 0.15 mm3，p < .001）相比，PWE 整体队列的视网膜结构指标，即 G-pRNFL 厚度（97.57 ± 9.06 µm）和 GCIP 体积（1.99 ± 0.13 mm3）明显较低。亚组分析显示，与 HC 相比，接受 SCB 药物治疗的 PWE 的 G-pRNFL 厚度（96.61 ± 9.70 µm，p = .01）和 GCIP 体积（1.98 ± 0.14 mm3，p < .001）显著减少，而未接受 SCB 药物治疗的 PWE（100.36 ± 6.32 µm，2.01 ± 0.13 mm3）与 HC 或接受 SCB 药物治疗的 PWE 没有差异。在视力测试（HCVA 和 LCVA）中，PWE 群体的总体得分（52.28 ± 8.56；31.71 ± 8.49）明显低于 HC（56.57 ± 4.74，p = .001；35.13 ± 5.50，p = .04）。在亚组分析中，只有使用 SCB 药物的 PWE 的 HCVA（51.25 ± 9.35，p = .003）和 LCVA（30.04 ± 8.93，p = .03）得分明显低于 HC，而未使用 SCB 药物的 PWE（55.25 ± 4.75，36.53 ± 4.50）和 HC 的视力得分没有差异。使用 SCB 药物的 PWE 的 LCVA 分数明显低于未使用 SCB 药物的 PWE（p = 0.03）。重要的是，无论是在总体样本中，还是在任何亚组中，均未发现视力评分与结构参数之间存在关联：意义：PWE 患者视网膜神经轴突缺失与高低对比度下视力下降无关。相反，我们的研究结果强化了SCB药物摄入量是导致高、低对比度下视力下降的重要因素。

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Visual acuity in the context of retinal neuroaxonal loss in people with epilepsy

Objective

Recent studies reported a significant retinal neuroaxonal loss in people with epilepsy (PWE). However, the impact of these structural alterations on visual function, i.e., visual acuity is yet unknown.

Methods

In this prospective cohort study, 70 PWE and 76 healthy controls (HC), all aged 18–55 years, underwent an assessment of visual acuity with 100 % high contrast (HCVA) and 2.5 % low contrast (LCVA) Sloan letter charts. Thickness of the global peripapillary retinal nerve fiber layer (G-pRNFL) and volume of the ganglion cell inner plexiform layer (GCIP) were assessed with spectral-domain optical coherence tomography (OCT). For the statistical analyses, the epilepsy group was subdivided into PWE with sodium channel blocking (SCB)-drug intake (n = 52) and PWE without SCB-drug intake (n = 18), since an effect of SCB-drugs on visual perception has been reported previously.

Results

The overall PWE cohort presented significantly lower structural retinal measures, i.e., G-pRNFL thickness (97.57 ± 9.06 µm) and GCIP volume (1.99 ± 0.13 mm³) than HC (101.31 ± 8.28 µm, p = .01; 2.10 ± 0.15 mm³, p < .001). Subgroup analyses revealed that PWE who were treated with SCB-drugs had a significantly reduced G-pRNFL thickness (96.61 ± 9.70 µm, p = .01) and GCIP volume (1.98 ± 0.14mm³, p < .001) compared to HC, while PWE without SCB-drugs (100.36 ± 6.32 µm, 2.01 ± 0.13 mm³) did not differ from HC or PWE with SCB-drugs. In visual acuity tests (HCVA and LCVA), the overall PWE cohort (52.28 ± 8.56; 31.71 ± 8.49) scored significantly lower than HC (56.57 ± 4.74, p = .001; 35.13 ± 5.50, p = .04). In subgroup analyses only PWE with SCB-drugs presented significantly lower HCVA (51.25 ± 9.35, p = .003) and LCVA (30.04 ± 8.93, p = .03) scores compared to HC, while visual acuity scores did not differ between PWE without SCB-drugs (55.25 ± 4.75, 36.53 ± 4.50) and HC. PWE with SCB-drugs had significantly lower LCVA scores than PWE without SCB-drugs (p = .03). Importantly, no association was found between visual acuity scores and structural parameters, neither in the overall sample, nor in any of the subgroups.

Significance

Retinal neuroaxonal loss in PWE was not associated with reduced visual acuity under high and low contrast. Instead, our findings reinforce SCB-drug intake as an important factor for reduced visual acuity under high and low contrast.

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来源期刊

Seizure-European Journal of Epilepsy 医学-临床神经学

CiteScore

5.60

自引率

6.70%

发文量

231

审稿时长

34 days

期刊介绍： Seizure - European Journal of Epilepsy is an international journal owned by Epilepsy Action (the largest member led epilepsy organisation in the UK). It provides a forum for papers on all topics related to epilepsy and seizure disorders.