Burakgazi Evren, Pollard John, Harden Cynthia
Department of Neurology, UMDNJ-Cooper University Medical Center, Camden, NJ, USA.
Rev Neurol Dis. 2011;8(1-2):16-22.
Epilepsy is one of the most common neurologic conditions seen by obstetricians, primary care physicians, and neurologists. It is present in three to five per 1000 births, and most women with epilepsy (WWE) can expect to have a normal pregnancy and delivery. The clinician's goal is to establish the best seizure control with the fewest possible number of antiepileptic drugs (AEDs) prior to pregnancy. Clinicians need to be aware of how the pharmacokinetic features of AEDs change during the pregnancy and postpartum period. During pregnancy AED concentrations may decrease, thereby increasing the risk of seizure deterioration. Levels of some AEDs must be monitored and the doses adjusted routinely during pregnancy and after birth. Understanding and applying these principles will ensure better seizure control during and after pregnancy and minimize the risk to the mother and the fetus due to recurrent seizures and fluctuating AED levels. This review emphasizes significant changes in pharmacokinetics of AEDs, the importance of monitoring serum concentration of AEDs, and routine dose adjustment prior to conception and during pregnancy and the postpartum period.
癫痫是产科医生、初级保健医生和神经科医生诊治的最常见神经系统疾病之一。每1000例分娩中有3至5例患有癫痫，大多数癫痫女性（WWE）有望正常妊娠和分娩。临床医生的目标是在怀孕前使用尽可能少的抗癫痫药物（AED）实现最佳的癫痫控制。临床医生需要了解AED的药代动力学特征在孕期和产后如何变化。孕期AED浓度可能降低，从而增加癫痫发作恶化的风险。在孕期和产后，必须监测某些AED的水平并定期调整剂量。理解并应用这些原则将确保孕期和产后更好地控制癫痫发作，并将因癫痫反复发作和AED水平波动对母亲和胎儿造成的风险降至最低。本综述强调了AED药代动力学的显著变化、监测AED血清浓度的重要性以及受孕前、孕期和产后的常规剂量调整。
