女性癫痫的管理
Managing Epilepsy in Women.
作者信息
Gerard Elizabeth E, Meador Kimford J
出版信息
Continuum (Minneap Minn). 2016 Feb;22(1 Epilepsy):204-26. doi: 10.1212/CON.0000000000000270.
PURPOSE OF REVIEW
Caring for a woman with epilepsy requires familiarity with the implications of antiepileptic drugs (AEDs) for pregnancy and contraception as well as an understanding of the effects of female hormones on epilepsy.
RECENT FINDINGS
AED pregnancy registries and prospective studies of cognitive development continue to confirm that valproate poses a significantly increased risk of structural and cognitive teratogenesis. In contrast, data thus far suggest that lamotrigine and levetiracetam are associated with a relatively low risk for both anatomic and developmental adverse effects, although further studies are needed for these and other AEDs. The intrauterine device is a good contraceptive option for many women with epilepsy as it is highly effective and not subject to the drug-drug interactions seen between hormonal contraception and many AEDs. Hormonal-sensitive seizures are common among women with epilepsy; however, highly effective treatments for refractory catamenial seizures are limited.
SUMMARY
Women with epilepsy should be counseled early and regularly about reproductive health as it relates to epilepsy. AED selection for women of childbearing age should take future pregnancies and contraceptive needs into consideration.
综述目的
照料癫痫女性患者需要熟悉抗癫痫药物（AEDs）对妊娠和避孕的影响，以及了解女性激素对癫痫的作用。
最新发现
AED妊娠登记处和认知发育前瞻性研究继续证实丙戊酸盐会显著增加结构和认知致畸风险。相比之下，目前的数据表明拉莫三嗪和左乙拉西坦对解剖学和发育方面的不良反应风险相对较低，不过这些药物以及其他AEDs仍需进一步研究。宫内节育器对许多癫痫女性来说是一种很好的避孕选择，因为它非常有效，且不会出现激素避孕与许多AEDs之间的药物相互作用。激素敏感性癫痫在癫痫女性中很常见；然而，针对难治性经期癫痫的高效治疗方法有限。
总结
应尽早并定期向癫痫女性提供有关与癫痫相关的生殖健康的咨询。育龄期女性选择AED时应考虑未来妊娠和避孕需求。
Zotero 插件