Müffelmann B, Bien C G
Epilepsie-Zentrum Bethel, Krankenhaus Mara I, Maraweg 17-21, 33617, Bielefeld, Deutschland.
Nervenarzt. 2016 Oct;87(10):1115-1126. doi: 10.1007/s00115-016-0210-1.
In the vast majority of women with epilepsy, no complications occur during pregnancy. Important for that is early, preconceptional counseling and close surveillance during pregnancy. The aim should be to maintain the best possible seizure control without occurrence of generalized tonic-clonic seizures while using antiepileptic drugs and with the lowest possible risk of malformations. The warnings for the prescription of valproic acid in women of reproductive age were tightened because of the dose-dependent increase in the malformation rate and other risks, especially regarding adverse effects on childhood cognitive development. The pharmacokinetics of antiepileptic drugs in pregnancy require monitoring of serum drug levels and an early dose adjustment. Breastfeeding should be encouraged in women with epilepsy taking antiepileptic drugs as long as infants are closely monitored with respect to possible sedation and poor drinking.
在绝大多数癫痫女性患者中，孕期不会出现并发症。对此至关重要的是孕前尽早进行咨询以及孕期密切监测。目标应是在使用抗癫痫药物时，在不发生全身强直阵挛性发作的情况下尽可能维持最佳的癫痫控制，同时使畸形风险降至最低。由于畸形率和其他风险呈剂量依赖性增加，尤其是对儿童认知发育的不良影响，育龄女性使用丙戊酸的处方警告已收紧。孕期抗癫痫药物的药代动力学需要监测血清药物水平并尽早调整剂量。对于服用抗癫痫药物的癫痫女性，只要对婴儿可能出现的镇静和吸吮不良情况进行密切监测，就应鼓励母乳喂养。
