Vigabatrin을 투여 받은 소아에서의 시야 결손

Abstract

Purpose: Vigabatrin has proved to be a successful and well tolerated drug used for the treatment of epilepsy of partial onset and for infantile spasms(West's syndrome). It is a selective and irreversible inhibitor of gamma-aminobutyric acid transaminase that is associated with visual field defect. We performed this study to investigate visual field defects in children treated with Vigabatrin. Methods: We performed a complete neuroophthalmologic examination and electrophysiologic studies on 28 patients receiving Vigabatrin. They underwent static perimetry using either full field 81 points or central 30-2 threshold screening program on the Humphrey visual field analyser, followed by the ophthalmic examination to rule out ocular causes for visual field defects. Results: The patients had a mean age of 11.9±3.1 years and the mean treatment duration with Vigabatrin was 14.9 months. 11 of 28 patients were abnormal on static perimetry. Among them, four were false negative, one was false positive and two had fixation loss, which were suggestive of poor cooperation. Four of them had visual field defects including right homonymous inferior quadrantanopia, left incongruous incomplete hemianopsia, bilateral right homonymous hemianopsia, bilateral left homonymous hemianopsia. Conclusion: Visual field examination in children is more difficult than in adults because of a lack of cooperation. Although we could not find any patients with visual field defect from Vigabatrin, vigilance and close follow up are necessary when the drug is prescribed.

Vigabatrin(VGB)에 의한 무증상성 양측성 시야결손에 관한 많은 보고와는 달리 본 연구에서는 시야 축소의 경우를 관찰할 수 없었다. 이는 Vigabatrin(VGB)의 투여기간이 다른 연구에 비해 평균 14개월로 짧았던 점과 자동 시야계 검사를 시행한 소아의 부적절한 협조로 인한 검사의 부정확성도 생각할 수 있다. 이를 보완하기 위하여 VEP(visual evoked potential) 방법 등 다각적인 연구가 필요할 것으로 생각하며, Vigabatrin을 처방함에 있어서 주의와 정기적인 시야 측정이 필요할 것으로 사료된다.