Klinikum der Universität München - Großhadern, München, Germany.
Dtsch Arztebl Int. 2010 Nov;107(45):787-93. doi: 10.3238/arztebl.2010.0787. Epub 2010 Nov 12.
Women with epilepsy and their doctors are often unsure of the implications of the disease and the limitations it causes. There is a major need for counseling.
Selective review of the literature as of November 2009.
Recommendations on pregnancy and childbearing for women with epilepsy can be found in the guidelines issued by the German Societies of Neurology and Epileptology and by the American Epilepsy Society. Only low-level evidence is available on other relevant questions, including contraception, the influence of hormones on epilepsy, and the influence of antiepileptic drugs on endocrine and bone metabolism, because of a lack of controlled studies. Polycystic ovarian syndrome is more commonly seen in women with epilepsy who take valproate. Antiepileptic drugs that induce CYP3a can diminish the efficacy of oral contraceptives; conversely, oral contraceptives can markedly lower the blood levels of antiepileptic drugs. According to the most recent studies, the risk of congenital malformations and spontaneous abortions is 1% to 2% in the normal population and 3% to 9% in the offspring of women with epilepsy who are taking antiepileptic drugs. Women with epilepsy who want to have children are currently advised to take folic acid prophylactically starting before conception and until the end of the first trimester. New mothers with epilepsy are advised to breastfeed their children.
Proper treatment and counseling of women with epilepsy, with due attention to aspects that are specific to women patients, can reduce the limitations to which they are subject in everyday life.
患有癫痫的女性及其医生常常对该疾病及其导致的限制感到困惑。因此，她们非常需要接受咨询。
截至 2009 年 11 月，对文献进行选择性回顾。
德国神经病学学会和癫痫学会以及美国癫痫学会发布的指南中可以找到有关患有癫痫的女性妊娠和生育的建议。其他相关问题，包括避孕、激素对癫痫的影响以及抗癫痫药物对内分泌和骨代谢的影响，仅有低水平的证据，这是因为缺乏对照研究。服用丙戊酸的癫痫女性更常患有多囊卵巢综合征。诱导 CYP3a 的抗癫痫药物会降低口服避孕药的疗效；相反，口服避孕药会显著降低抗癫痫药物的血药浓度。根据最新研究，在正常人群中，先天性畸形和自然流产的风险为 1%至 2%，而正在服用抗癫痫药物的癫痫女性的后代中，这一风险为 3%至 9%。目前建议有生育要求的癫痫女性在受孕前开始预防性服用叶酸，直至孕早期结束。建议患有癫痫的新妈妈母乳喂养孩子。
适当治疗和咨询患有癫痫的女性，并特别关注女性患者的特定方面，可以减少她们日常生活中面临的限制。
