Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Epilepsy Centre, Department of Neurophysiology and Experimental Epileptology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Neurological Institute "Carlo Besta" Foundation, Milan, Italy.
Lancet Neurol. 2016 Feb;15(2):210-218. doi: 10.1016/S1474-4422(15)00314-2. Epub 2015 Dec 5.
Since the serendipitous discovery of its anticonvulsant properties more than 50 years ago, valproic acid has become established as an effective broad-spectrum antiepileptic drug that is particularly useful for the management of generalised epilepsies, for which treatment alternatives are few. However, during the past few years increasing evidence has accumulated that intake of valproic acid during pregnancy is associated with a significant risk of dose-dependent teratogenic effects and impaired postnatal cognitive development in children. Because of these risks, valproic acid should not be used as a first-line drug in women of childbearing potential whenever equally or more effective alternative drugs are available-as in the case of focal epilepsy. In some generalised epilepsy syndromes, such as juvenile myoclonic epilepsy, valproic acid has better documented efficacy than alternative drugs and drug selection should be a shared decision between the clinician and the informed patient based on careful risk-benefit assessment.
自 50 多年前偶然发现其抗惊厥特性以来，丙戊酸已成为一种有效的广谱抗癫痫药物，特别适用于治疗全身性癫痫，因为这种疾病的治疗选择很少。然而，在过去几年中，越来越多的证据表明，怀孕期间摄入丙戊酸与剂量依赖性致畸作用和儿童出生后认知发育受损的显著风险相关。由于这些风险，只要有同样或更有效的替代药物可用，丙戊酸就不应该在有生育能力的女性中作为一线药物使用——例如在局灶性癫痫的情况下。在一些全身性癫痫综合征中，如青少年肌阵挛性癫痫，丙戊酸比替代药物有更好的疗效，药物选择应该是临床医生和知情患者之间基于仔细的风险效益评估的共同决策。
