Mikkonen K, Vainionpää L K, Pakarinen A J, Knip M, Järvelä I Y, Tapanainen J S, Isojärvi J I
Department of Pediatrics, University of Oulu, Finland.
Neurology. 2004 Feb 10;62(3):445-50. doi: 10.1212/01.wnl.0000106942.35533.62.
To evaluate the outcome of epilepsy and later reproductive endocrine health in girls who had epilepsy during puberty, using a population-based controlled study.
Sixty-nine patients (88%) and 51 control subjects (94%) of previously identified cohorts of 78 girls with epilepsy and 54 healthy control girls participated in this study (initial age 8 to 18.5 years, at follow-up 12.5 to 25.8 years). Thirty-five of the patients were initially taking valproate (VPA), 17 carbamazepine, and 17 oxcarbazepine as monotherapy. Most of the patients (61%) were off medication. All the subjects were examined clinically, the medical and menstrual histories were obtained, ovarian ultrasonography was examined, and serum reproductive hormone concentrations were analyzed.
There were no significant differences in laboratory or clinical findings between the patients off medication and the control subjects. Postpubertal patients on medication had higher serum testosterone (1.9 nmol/L, SD 0.7 nmol/L) and androstenedione (18.8 nmol/L, SD 15.2 nmol/L) levels than patients off medication (1.4 nmol/L, SD 0.5 nmol/L, and 9.5 nmol/L, SD 2.6 nmol/L) or control subjects (1.4 nmol/L, SD 0.5 nmol/L, and 10.2 nmol/L, SD 3.2 nmol/L) (all comparisons p < 0.02). All patients still on VPA had elevated serum androstenedione levels. Polycystic ovary syndrome was more common in patients on medication (38%; in 63% on VPA, in 25% on other medication) than in patients off medication (6%) or in controls (11%) (p = 0.005).
Epilepsy during pubertal maturation does not affect reproductive endocrine health in female subjects who discontinue the medication before adulthood. However, an increased prevalence of endocrine disorders is detected if the patients remain on antiepileptic drugs, especially VPA, until adulthood.
采用基于人群的对照研究,评估青春期患癫痫的女孩癫痫发作的结果及后期生殖内分泌健康状况。
先前确定的78名癫痫女孩队列中的69名患者(88%)和54名健康对照女孩队列中的51名对照者(94%)参与了本研究(初始年龄8至18.5岁,随访时年龄12.5至25.8岁)。35名患者最初服用丙戊酸盐(VPA),17名服用卡马西平,17名服用奥卡西平作为单一疗法。大多数患者(61%)已停药。对所有受试者进行临床检查,获取病史和月经史,进行卵巢超声检查,并分析血清生殖激素浓度。
停药患者与对照者在实验室检查或临床发现方面无显著差异。青春期后仍在服药的患者血清睾酮(1.9 nmol/L,标准差0.7 nmol/L)和雄烯二酮(18.8 nmol/L,标准差15.2 nmol/L)水平高于停药患者(1.4 nmol/L,标准差0.5 nmol/L和9.5 nmol/L,标准差2.6 nmol/L)或对照者(1.4 nmol/L,标准差0.5 nmol/L和10.2 nmol/L,标准差3.2 nmol/L)(所有比较p<0.02)。所有仍在服用VPA的患者血清雄烯二酮水平均升高。多囊卵巢综合征在服药患者中(38%;服用VPA的患者中为63%,服用其他药物的患者中为25%)比停药患者(6%)或对照者(11%)更常见(p = 0.005)。
青春期成熟期间患癫痫对成年前停药的女性受试者的生殖内分泌健康无影响。然而,如果患者在成年前一直服用抗癫痫药物,尤其是VPA,则会发现内分泌疾病的患病率增加。