The Epilepsy Clinic, Department of Neurology, University State Hospital, Rigshospitalet, Copenhagen, Denmark.
Acta Neurol Scand. 2012 Jul;126(1):e1-4. doi: 10.1111/j.1600-0404.2011.01627.x. Epub 2011 Dec 9.
Treatment with lamotrigine (LTG) during pregnancy is associated with a pronounced risk of seizure deterioration, because pregnancy accelerates LTG elimination. The extent to which pregnancy affects LTG pharmacokinetics is unpredictable and varies considerably among patients.
We propose an algorithm for systematic LTG plasma concentration monitoring and dose adjustment to guide the clinician between the risk of seizure deterioration and LTG toxicity by maintaining a stable LTG concentration, using the optimal prepregnancy target concentration as a reference.
The reference LTG plasma concentration (RC) should be determined before pregnancy or as early in pregnancy as possible. After conception, plasma concentration of LTG should be measured every 4 weeks throughout pregnancy. When the LTG plasma concentration falls below the RC, the dose of LTG should be increased by 20-25%. Post-partum, the plasma concentration of LTG should be measured within the first or second week, and if the LTG plasma concentration is higher than the RC, the LTG dose should be reduced by 20-25% and the procedure repeated until RC is re-established.
Seizure deterioration during pregnancy may be prevented or reduced by closely and systematically following our proposed algorithm.
妊娠期间使用拉莫三嗪（LTG）治疗与癫痫恶化的风险显著相关，因为妊娠会加速 LTG 的消除。妊娠对 LTG 药代动力学的影响程度不可预测，且在患者之间差异很大。
我们提出了一种 LTG 血浆浓度监测和剂量调整的系统算法，通过维持稳定的 LTG 浓度，以最佳的孕前目标浓度为参考，指导临床医生在癫痫恶化和 LTG 毒性之间的风险之间进行权衡。
应在妊娠前或妊娠早期尽可能确定参考 LTG 血浆浓度（RC）。妊娠后，整个妊娠期间应每 4 周测量一次 LTG 血浆浓度。当 LTG 血浆浓度低于 RC 时，应将 LTG 剂量增加 20-25%。产后，应在第一或第二周内测量 LTG 血浆浓度，如果 LTG 血浆浓度高于 RC，则应将 LTG 剂量减少 20-25%，并重复该过程，直到重新建立 RC。
通过密切和系统地遵循我们提出的算法，可以预防或减少妊娠期间的癫痫恶化。
