Kashif Tooba, Fathima Nida, Usman Norina, Qaseem Aisha, Jayaraj Joseph S
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Internal Medicine, Veterans Affairs Palo Alto Health Care System - Stanford University School of Medicine, Palo Alto, USA.
Cureus. 2019 Sep 13;11(9):e5642. doi: 10.7759/cureus.5642.
Epilepsy is a chronic neurological condition that requires treatment throughout the pregnancy. Seizures should be well controlled before conception with a specific type of anti-epileptic drug (AED) for each epileptic syndrome. The selection of AED is crucial in women with epilepsy (WWE). AEDs with the lowest malformations rates should be used for treatment during pregnancy. Valproate should be avoided in WWE of childbearing age as it is associated with the highest risk of neurocognitive malformations. However, pregnancy might alter the levels of AEDs, which can lead to an increase in seizure frequency. It is important to monitor AED levels and make necessary dose adjustments to control seizures during pregnancy. WWE should be treated with the lowest possible dose allowed and preferably with a single AED to avoid harmful effects on the developing fetus. Women should be counseled to take folic acid during pregnancy as it reduces the risks for cardiovascular, genitourinary, and neural tube defects. Generally, WWE usually have normal pregnancies and can bear healthy offspring. Pregnant women need continuous follow-up in a coordinated manner with the neurologist and obstetrician to assess for adverse pregnancy and fetal outcomes.
癫痫是一种慢性神经系统疾病，整个孕期都需要进行治疗。在受孕前，应使用针对每种癫痫综合征的特定类型抗癫痫药物（AED）将癫痫发作控制良好。对于癫痫女性（WWE）而言，AED的选择至关重要。孕期治疗应使用致畸率最低的AED。育龄期WWE应避免使用丙戊酸盐，因为其与神经认知畸形的风险最高相关。然而，怀孕可能会改变AED的血药浓度，进而导致癫痫发作频率增加。孕期监测AED血药浓度并进行必要的剂量调整以控制癫痫发作非常重要。WWE应以允许的最低剂量进行治疗，最好使用单一AED，以避免对发育中的胎儿产生有害影响。应建议女性在孕期服用叶酸，因为这可降低心血管、泌尿生殖系统和神经管缺陷的风险。一般来说，WWE通常能正常妊娠并诞下健康后代。孕妇需要在神经科医生和产科医生的协同下进行持续随访，以评估不良妊娠和胎儿结局。
