Thomas Sanjeev V
R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Ann Indian Acad Neurol. 2015 Jul-Sep;18(3):278-83. doi: 10.4103/0972-2327.162261.
Contraception is an important choice that offers autonomy to women with regard to prevention of unintended pregnancies. There is wide variation in the contraceptive practices between continents, countries, and societies. The medical eligibility for contraception for sexually active women with epilepsy (WWE) is determined by the type of anti-epileptic drugs (AEDs) that they use. Enzyme inducing AEDs such as phenobarbitone, phenytoin, carbamazepine, and oxcarbazepine increase the metabolism of orally administered estrogen (and progesterone to a lesser extent). Estrogen can increase the metabolism of certain AEDs, such as lamotrigine, leading to cyclical variation in its blood level with resultant adverse effect profile or seizure dyscontrol. AEDs and sex hormones can increase the risk of osteoporosis and fracture in WWE. The potential interactions between AEDs and hormonal contraception need to be discussed with all women in reproductive age-group. The alternate options of oral contraception such as intrauterine copper device, intrauterine levonorgestrel release system, and supplementary protection with barriers need to be presented to them. World Health Organization has recommended to avoid combination contraceptive pills containing estrogen and progesteron in women who desire contraception and in breastfeeding mothers. Care providers need to consider the option of non-enzyme-inducing AEDs while initiating long-term treatment in adolescent and young WWE.
避孕是一项重要选择，能让女性在预防意外怀孕方面拥有自主权。各大洲、各个国家和社会的避孕措施存在很大差异。患有癫痫的性活跃女性（WWE）的避孕医学适用性取决于她们所使用的抗癫痫药物（AED）类型。酶诱导型抗癫痫药物，如苯巴比妥、苯妥英、卡马西平和奥卡西平，会增加口服雌激素（以及在较小程度上增加孕激素）的代谢。雌激素会增加某些抗癫痫药物（如拉莫三嗪）的代谢，导致其血药浓度出现周期性变化，从而产生不良反应或癫痫控制不佳。抗癫痫药物和性激素会增加WWE患骨质疏松症和骨折的风险。需要与所有育龄期女性讨论抗癫痫药物与激素避孕之间的潜在相互作用。应向她们介绍口服避孕的替代选择，如宫内铜节育器、宫内左炔诺孕酮释放系统以及屏障辅助保护措施。世界卫生组织建议，对于希望避孕的女性以及哺乳期母亲，应避免使用含有雌激素和孕激素的复方避孕药。医疗服务提供者在对青春期和年轻的WWE开始长期治疗时，需要考虑使用非酶诱导型抗癫痫药物。
