Chang S I, McAuley J W
College of Pharmacy, Ohio State University, Columbus 43210, USA.
Ann Pharmacother. 1998 Jul-Aug;32(7-8):794-801. doi: 10.1345/aph.17253.
To provide an overview of key pharmacotherapeutic issues in epilepsy for the woman of childbearing potential.
A MEDLINE search (1966-1997) was done to identify pertinent literature. Chapters in epilepsy textbooks, pregnancy registries, and their respective bibliographies were also evaluated.
All identifiable sources written in English were evaluated.
Epilepsy is a common neurologic disorder. It is estimated that nearly 1 million American women of childbearing age have epilepsy. There are many women's health issues in epilepsy. These include menstrual cycle influences on seizure activity, contraceptive-antiepileptic drug interactions, pharmacokinetic changes during pregnancy, teratogenicity of antiepileptic drugs, breast-feeding, and quality of life. These issues challenge both the woman with epilepsy and the many healthcare providers involved in her care. This article reviews these issues and makes recommendations. It addresses both the first-generation antiepileptic drugs (phenobarbital, phenytoin, carbamazepine, valproic acid) and the newer or second-generation agents (felbamate, gabapentin, lamotrigine, topiramate, tiagabine).
CONCLUSIONS/RECOMMENDATIONS: Drug interactions between enzyme-inducing antiepileptic drugs and contraceptives are well documented. Higher doses of oral contraceptives or a second contraceptive method are suggested if epileptic women use an enzyme-inducing antiepileptic drug. Planned pregnancy is highly recommended and counseling before conception is crucial. Prepregnancy counseling should include, but is not limited to, folic acid supplementation, optimal control of seizure activity, monotherapy with the lowest effective antiepileptic drug dose, and medication adherence. Patient information should be provided about the risk of teratogenicity and the importance of prenatal care. Antiepileptic drug dosage adjustments may be necessary and should be based on clinical symptoms, not solely on serum drug concentrations. While the future holds promise for many aforementioned women's issues in epilepsy, many questions remain to be answered.
概述育龄期癫痫女性的关键药物治疗问题。
进行了MEDLINE检索（1966 - 1997年）以确定相关文献。还对癫痫教科书章节、妊娠登记处及其各自的参考文献进行了评估。
对所有可识别的英文文献进行评估。
癫痫是一种常见的神经系统疾病。据估计，近100万美国育龄期女性患有癫痫。癫痫存在许多女性健康问题。这些问题包括月经周期对癫痫发作活动的影响、避孕药与抗癫痫药物的相互作用、孕期药代动力学变化、抗癫痫药物的致畸性、母乳喂养以及生活质量。这些问题对癫痫女性以及参与其护理的众多医疗服务提供者都构成了挑战。本文回顾了这些问题并提出建议。文章涉及第一代抗癫痫药物（苯巴比妥、苯妥英、卡马西平、丙戊酸）以及更新的或第二代药物（非氨酯、加巴喷丁、拉莫三嗪、托吡酯、噻加宾）。
结论/建议：酶诱导性抗癫痫药物与避孕药之间的药物相互作用已有充分记录。如果癫痫女性使用酶诱导性抗癫痫药物，建议增加口服避孕药剂量或采用第二种避孕方法。强烈建议有计划地怀孕，受孕前的咨询至关重要。孕前咨询应包括但不限于补充叶酸、癫痫发作活动的最佳控制、使用最低有效抗癫痫药物剂量进行单药治疗以及药物依从性。应向患者提供致畸风险及产前护理重要性的信息。可能需要调整抗癫痫药物剂量，且应基于临床症状，而非仅依据血清药物浓度。虽然未来上述许多癫痫女性问题有望得到解决，但仍有许多问题有待解答。
