BÁO CÁO MỘT TRƯỜNG HỢP ĐIỀU TRỊ HỖ TRỢ NGỘ ĐỘC THUỐC KHÁNG LAO VỚI PIRACETAM

Abstract

Objective: To evaluate the supportive treatment efficacy of Piracetam in a casse of Ethambutol-induced optic neuropathy (EON). Methods: Off label treatment trial of a clinical case report of a 38-year-old female patient presenting with rapidly progressive bilateral vision loss in 4 consecutive months after 5 months of Ethambutol therapy. Past medical history included myopia. Initial visual acuity (VA) was counting fingers (CF) 2m OD and CF 3m OS; pinhole vision was 1/10 OU; no improvement with refraction. Anterior segment examination was normal; fundus showed no optic disc damage. OCT of the optic nerve revealed thinning of the ganglion cell layer. Systemic examination, liver and renal function tests were normal. Treatment protocol: intravenous injection Piracetam 12g/day for up to three treatment cycles, each lasting 10 consecutive days with a 10-day break between cycles. Treatment was discontinued once optimal visual acuity was achieved.  Results: The patient received two treatment cycles with intravenous Piracetam 12g/day. After the first 10-day cycle, visual acuity improved to 4/10 OU. After the second 5-day cycle, vissual acuity was 8/10. After 10 days post-treatment, vision acuity reached 10/10, with complete resolution of myopia. OCT optic nerve 1 month following revealed normalization of the ganlion cell layer. No adverse effects of Piracetam were observed. At 3-month follow-up, vision remained 10/10. Conclusion:  Ethambutol-induced optic neuropathy is a notable adverse effect during tuberculosis treatment. The main treatment is to discontinue ethambutol, as vision may either partially recover spontaneously or worsen. Currently, no specific treatment exists. Common supportive therapies include B-complex vitamins supplyment, especially B1 and B12. However, this off-label trial of supportive treatment with Piracetam suggests that Piracetam may significantly accelerate and enhance visual recovery in such cases.