Tatum William O, Liporace Joyce, Benbadis Selim R, Kaplan Peter W
Department of Neurology, Tampa General Hospital, University of South Florida, Tampa 33613, USA.
Arch Intern Med. 2004 Jan 26;164(2):137-45. doi: 10.1001/archinte.164.2.137.
Epilepsy is a condition of the central nervous system that is characterized by recurrent seizures. The goal of management is to make patients seizure free without intolerable adverse effects from treatment. Men and women differ in their physiologic makeup and therefore have different needs that must be considered when attempting to attain this goal. There are special concerns for women of child-bearing years with regard to contraception, pregnancy, and teratogenicity that should be considered during counseling and selection of appropriate treatment. There are also emerging concerns about the interaction of antiepileptic drugs and endocrine function that can affect ovarian function, induce polycystic ovary (PCO)-like syndrome, and threaten fertility. Systemic adverse effects can have a negative impact on weight, cosmetic appearance, sexual function, and bone health. Individualized treatment coupling antiepileptic drug use and the specific phase of impact of the reproductive cycle must be considered in treatment selection. Important concerns regarding long-term therapy are being raised as there are more treatment options to consider because of the plethora of new antiepileptic drugs that are available, often with more favorable pharmacokinetics and different adverse event profiles. Also, sex hormone fluctuations during maturation may exacerbate seizures at particular points during the life cycle for women, including menarche, during menses, during pregnancy, or later in the perimenopausal years, often presenting a uniquely challenging aspect to treatment. As the number of available treatment options for epilepsy increases, the optimal goal for primary care physicians is to work as a team with obstetricians, gynecologists, and neurologists in an effort to ensure the best treatment of women with epilepsy.
癫痫是一种中枢神经系统疾病，其特征为反复发作的癫痫发作。治疗的目标是使患者无癫痫发作，且无难以耐受的治疗不良反应。男性和女性的生理构成不同，因此在试图实现这一目标时，有不同的需求必须加以考虑。育龄期女性在避孕、妊娠和致畸性方面有特殊问题，在咨询和选择合适治疗方法时应予以考虑。抗癫痫药物与内分泌功能的相互作用也日益受到关注，这种相互作用会影响卵巢功能、诱发多囊卵巢（PCO）样综合征并威胁生育能力。全身性不良反应会对体重、外貌、性功能和骨骼健康产生负面影响。在选择治疗方法时，必须考虑将抗癫痫药物的使用与生殖周期的特定影响阶段相结合的个体化治疗。由于有大量新的抗癫痫药物可供选择，且其往往具有更有利的药代动力学和不同的不良事件谱，因此对于长期治疗提出了重要问题。此外，女性在成熟过程中的性激素波动可能在生命周期的特定阶段加重癫痫发作，包括初潮、月经期间、怀孕期间或围绝经期后期，这常常给治疗带来独特的挑战。随着癫痫可用治疗方法数量的增加，初级保健医生的最佳目标是与产科医生、妇科医生和神经科医生组成团队，努力确保对癫痫女性进行最佳治疗。
