Kispayeva T T, Nurakhmetova A S
National Center of Labour Hygiene and Occupational Diseases, Ministry of Health of the Republic of Kazakhstan, Karaganda, Kazakhstan.
Joint Stock Company Astana Medical University, Astana, Kazakhstan.
Zh Nevrol Psikhiatr Im S S Korsakova. 2018;118(7):101-103. doi: 10.17116/jnevro201811871101.
This review of literature is devoted to contemporary issues of antiepileptic therapy in pregnancy, with identifying the most effective drug according to publications from 2006 to 2016 (PUBMED, MEDline, The Cochrane Lb.). The review presents the current published data on the incidence of seizures in pregnant women, specificity of therapy with antiepileptic drugs (AEDs), frequency of fetal malformations in pregnant women taking AEDs regularly and their dependence on the frequency, dosage and nature of therapy. The authors studied and analyzed the literature on antiepileptic therapy with AED for the last ten years and selected AED with the least teratogenic effect and less side-effects. Lamotrigine, phenytoin, carbamazepine, valproic acid, phenobarbital were studied. In addition to classic AEDs, new AEDs (vigabatrin, gabapentin, topiramate, tiagabine, oxcarbazepine, levetiracetam, pregabalin) were investigated. Over the past decade, the use of new-generation AEDs has increased. It has been found that the risk of birth defects in children is associated with high doses of drugs and polytherapy compared to monotherapy. New data of recent studies showed the effect of psychotropic drugs on the fetus allowing to assess the 'risk/benefit' ratio and develop recommendations on rational pharmacotherapy of epilepsy in pregnancy.
本文献综述致力于探讨妊娠期抗癫痫治疗的当代问题，根据2006年至2016年的出版物（PUBMED、MEDline、Cochrane图书馆）确定最有效的药物。该综述呈现了关于孕妇癫痫发作发生率、抗癫痫药物（AEDs）治疗的特异性、定期服用AEDs的孕妇胎儿畸形的频率及其与治疗频率、剂量和性质的相关性的当前已发表数据。作者研究并分析了过去十年中关于使用AEDs进行抗癫痫治疗的文献，并挑选出致畸作用最小且副作用较少的AEDs。对拉莫三嗪、苯妥英、卡马西平、丙戊酸、苯巴比妥进行了研究。除了经典的AEDs，还对新型AEDs（氨己烯酸、加巴喷丁、托吡酯、噻加宾、奥卡西平、左乙拉西坦、普瑞巴林）进行了调查。在过去十年中，新一代AEDs的使用有所增加。已发现与单药治疗相比，高剂量药物和联合治疗会增加儿童出生缺陷的风险。近期研究的新数据显示了精神药物对胎儿的影响，从而能够评估“风险/获益”比，并制定妊娠期癫痫合理药物治疗的建议。
