López-Fraile Isabel P, Cid Antonio Oliveros, Juste Antonio Oliveros, Modrego Pedro J
Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Epilepsy Behav. 2009 Jul;15(3):372-5. doi: 10.1016/j.yebeh.2009.04.006. Epub 2009 May 27.
Variations in the plasma concentration of levetiracetam during pregnancy and postpartum were prospectively monitored in five women to investigate their potential implications in epilepsy management and child outcome. Under unchanged levetiracetam dosages, the mean concentrations of levetiracetam during the third trimester were 62% of the baseline late (12 month) postpartum levels, but only 47% of the baseline early postpartum (2 month) levetiracetam levels. In dual therapy with lamotrigine, baseline late postpartum levetiracetam clearance was 63.2%, whereas in early postpartum it was 45% of the maximal second-trimester clearance. However, the number of seizures remained unchanged once lamotrigine dose was increased. No woman had adverse effects during the puerperium. The mean umbilical cord/maternal plasma concentration ratio was 1.21. None of the newborns had malformations, with the anthropometric data being normal for their gestational age. The decline in gestational levetiracetam plasma concentration does not seem to be hazardous, but differs according to whether early or late postpartum levels are chosen as baseline levels.
前瞻性监测了5名女性在孕期和产后左乙拉西坦血浆浓度的变化，以研究其在癫痫管理和儿童结局方面的潜在影响。在左乙拉西坦剂量不变的情况下，孕晚期左乙拉西坦的平均浓度为产后晚期（12个月）基线水平的62%，但仅为产后早期（2个月）基线左乙拉西坦水平的47%。在与拉莫三嗪联合治疗时，产后晚期左乙拉西坦的基线清除率为63.2%，而在产后早期，其清除率为孕中期最大清除率的45%。然而，一旦增加拉莫三嗪剂量，癫痫发作次数保持不变。没有女性在产褥期出现不良反应。脐血/母体血浆浓度的平均比值为1.21。没有新生儿出现畸形，其人体测量数据与其孕周相符。孕期左乙拉西坦血浆浓度的下降似乎并无危害，但根据选择产后早期还是晚期水平作为基线水平而有所不同。
