加载中…
个人资料
freaky
freaky
  • 博客等级:
  • 博客积分:0
  • 博客访问:1,858
  • 关注人气:0
  • 获赠金笔:0支
  • 赠出金笔:0支
  • 荣誉徽章:
相关博文
推荐博文
谁看过这篇博文
加载中…
正文 字体大小:

女性与癫痫

(2010-01-16 21:38:09)
标签:

健康

分类: 神经病学

Pregnancy outcomes in women with epilepsy: A systematic review and meta-analysis of published pregnancy registries and cohorts.

Conclusions—Results of this systematic literature review suggest that the overall incidence of CMs in children born of WWE is approximately threefold that of healthy women. The risk is elevated for all AED monotherapy and further elevated for AED polytherapy compared to women without epilepsy. The risk was significantly higher for children exposed to valproate monotherapy and to polytherapy of 2 or more drugs when the polytherapy combination included phenobarital, phenytoin, or valproate. Further research is needed to delineate the specific risk for each individual AED and to determine underlying mechanisms including genetic risk factors.

1.有癫痫的怀孕妇女生出有先天异常的宝宝是健康妇女的三倍。
2.使用两种以上抗癫痫药物的危险比使用单一种药物的机会更高。
3.单一药物之中,使用valproate的危险性最高。
4.合并使用两种以上的抗癫痫药物之中,有使用phenobarital, phenytoin, or valproate的危险性最高。

 

Epilepsy Behav. 2009 Apr 30. [Epub ahead of print] Links
Antiepileptic Drug Use in Women of Childbearing Age.
Meador KJ, Penovich P, Baker GA, Pennell PB, Bromfield E, Pack A, Liporace JD, Sam M, Kalayjian LA, Thurman DJ, Moore E, Loring DW.
Neurology, Emory University, Atlanta, GA.
抗癫痫药应用于 育龄妇女
Research on antiepileptic drug (AED) teratogenesis has demonstrated an increased risk for valproate.
有证据表明抗癫痫药致机畸率增加来源于丙戊酸盐
The impact of these findings on current AED prescribing patterns for women of childbearing age with epilepsy is uncertain.
发现的原因在于现行的医生为 育龄妇女 开抗癫痫药时,对这一概念是不清楚的。
The NEAD Study is an ongoing prospective multicenter observational investigation, which enrolled pregnant women with epilepsy taking the most common AED monotherapies from 10/99 to 02/04 (carbamazepine, lamotrigine, valproate, and phenytoin).
NEAD研究是一前瞩性的、多中心的、观察研究,它登记了现服用抗癫痫药物的孕妇服用现在的常规剂量,单一疗法从10/99到02/04(卡马西平,拉莫三嗪, 丙戊酸盐, and 苯妥英钠).
A 2007 survey of AED use in women of childbearing age at eight NEAD centers found a total of 932 women of childbearing age with epilepsy (6% taking no AED, 53% monotherapy, 41% polytherapy).
一项2007年的在八个中心调查发现932名 育龄妇女 患有癫痫(6%服用抗癫痫药, 53% 为单一疗法, 41%服用多种制剂).

The most common monotherapies were lamotrigine and levetiracetam.
最常有的单一疗法是采用拉莫三嗪和左乙拉西坦
Since 2004, prescriptions of carbamazepine, phenytoin and valproate decreased while levetiracetam increased.
从2004年, 卡马西平、苯妥英和丙戊酸盐的剂量减少了然而左乙拉西坦的剂量增加了。
Except for the top two AED monotherapies, there were marked differences in other monotherapies and in polytherapies between USA and UK centers.
在USA和UK中心之间,除了最常用的两种单一的抗癫痫药外,在采用别的的单一药物和采用多种药物治疗癫痫时,标明了明显的差别。
Future investigations are needed to examine reasons for drug choice.
选择药物的理由需做进一步的研究。
译者言:
想要宝宝的癫痫女性患者 可以到天坛找丁成云老师 黄宇明老师 他们有办法让您少服或是不服癫痫药物 这样您就会有个健康的宝宝

 

AAN 2009:子宫内暴露到Valproate可能与儿童癫痫发作有关


作者:Caroline Cassels  
出处:WebMD医学新闻

  May 7, 2009(西雅图)-一项大型观察性研究初期分析数据显示,在子宫内暴露到抗癫痫药物valproate(Depakote、Depakote ER、Depakine、Depacon,亚培药厂)可能会增加儿童发生癫痫风险。然而,研究者提醒,这项研究结果并未达到统计上显着差异,且在初期阶段,研究的价值在於推动其他研究的进行。
  
  这项来自抗癫痫药物对神经发展效应(NEAD)研究的最新发现,是一项多中心、观察性前瞻性研究,比较母体接受四种最常见的抗癫痫药物,包括lamotrigine(Lamictal,格兰素史克药厂)、carbamazepine(Carbatrol,Shire药厂;Equetro,Validus药厂;Tegretol、Tegretol XR,诺华药厂)、phenytoin与valproate,对神经发展的效应,这项研究结果发表在美国神经医学会第61届年会上。
  
  来自乔治亚洲亚特兰大Emory大学的主要研究者Kimford J. Meador医师向Medscape神经学与神经外科学表示,在子宫内暴露到valproate的儿童发生癫痫的可能性似乎较高,是暴露到carbamazepine、phenytoin或是lamotrigine的2至3倍。但是我们在判读这项研究结果时必须十分地小心,因为该样本数目非常的少、且并未达到统计上显着差异。
  
  【在动物实验中,抗癫痫药物与神经迁移异常有关】
  来自NEAD研究最近发表的数据显示,valproate对儿童的认知功能发展有负面影响,相较於其他抗癫痫药物,这些儿童在三岁时的IQ分数显着较低。
  
  众所周知,在怀孕时喝酒会造成胎儿脑神经细胞死亡,造成认知功能受损。在动物实验中,其他的抗癫痫药物也有这样的作用。进一步的,最近的动物实验指出,在子宫中暴露到特定药物,包括抗癫痫药物,例如phenytoin或是valproate,也会造成发展中脑部神经迁移发生异常。当这种脑部神经迁移异常发生在人类时,可能造成神智发展迟缓或是癫痫。
  
  Meador医师表示,我对於暴露在特定药物是否对癫痫发作带来差异、或是在这方面我们是否可以观察到一些模式感到兴趣。
  
  【母体癫痫种类之间并无差异】
  研究者检验311位4岁儿童的癫痫发作频率,这些儿童自罹患癫痫的母体生产而来,癫痫的种类包括局部相关、先天性全身性、或是全身性张力性收缩性癫痫发作(GTCS),以及特定抗癫痫药物。
  
  从整个族群来看,188位女性有局部相关癫痫发作、99位有先天性全身性癫痫、24位有GTCS。自罹患局部相关癫痫与先天性全身性癫痫母体产下的儿童癫痫发作率分别为5.3%(10)与5.1%(5)。母体罹患GTCS的儿童没有癫痫发作的状况。
  
  分别有94、100、55与62位女性服用carbamazepine、lamotrigine、phenytoin与valproate。母体使用carbamazepine产下的儿童发生癫痫机率为4.3%、lamotrigine则是3.0%、phenytoin为3.6%以及valproate的9.7%。
  
  根据Meador医师表示,这项研究的样本数目太小,不足以做出任何确切的结论;但研究结果值得後续研究确认。
  
  Meador医师表示,我要让这些议题浮上台面,让其他研究者们会考虑在不同资料库、不同族群中寻找相似的讯号。
  
  这项研究由国家卫生研究院、国家神经疾患与中风机构赞助。Meader医师表示担任亚培药厂、Cyberonics、Eisai与葛兰素史克药厂、Neuropace、诺华药厂、Ortho McNeil与UCB公司的顾问,但是没有从这些个人活动中获取收入。

 

1: Epilepsia. 2008 Dec;49(12):2069-77. Epub 2008 May 21

Seizure type, antiepileptic drugs, and reproductive endocrine dysfunction in Indian women with epilepsy: a cross-sectional study.
印第安女性癫痫病人癫痫类型、抗癫痫药及生殖内分泌失调:横断面研究

BACKGROUND: There is paucity of data regarding occurrence of reproductive endocrine disorders in Asian women with epilepsy (WWE) on antiepileptic drug (AED) therapy.
背景:缺少亚洲女性癫痫病人抗癫痫药物治疗发生生殖内分泌失调相关资料。

PURPOSE: To determine the occurrence of reproductive endocrine disorders in Indian WWE, by seizure type and the AED use.
目的:明确印第安女性癫痫病人发生生殖内分泌失调与发作类型及所用抗癫痫药物之间的关系。

METHODS: Consecutive 427 reproductive age WWE receiving various AEDs were screened for the occurrence of menstrual abnormalities, weight change, and hirsutism. Of these, 53 WWE with menstrual disturbances and/or hirsutism were further uated for ovarian morphology and reproductive hormonal profile.
方法:连续的427例接受不同的抗癫痫药治疗的育龄女性癫痫病人对其发生月经异常、体重改变和多毛症进行筛查。当然,对53例患有月经不调和/或多毛症女性癫痫病人卵巢的形态学和生殖激素进行进一步评估。

RESULTS: Menstrual abnormalities and/or hirsutism were observed in 83 of 427 (19.4%) WWE irrespective of epileptic seizure type; of these, 50 (60.2%) received valproate, 21 (25.3%) received carbamazepine, 11 (13.3%) received phenytoin, and one (1.2%) received phenobarbitone as the primary AED. Almost half of valproate-treated women had significant weight gain and obesity. Among 53 of 83 women uated further, 23.5% and 63.6% of valproate-treated women, 25% and 58.3% of carbamazepine-treated women, and none and 20% of phenytoin-treated women had polycystic ovaries (PCO) and hyperandrogenemia (HA), respectively. Valproate-treated women had significantly higher frequency of polycystic ovarian syndrome (PCOS) (11.8% vs. 2.5%, p < 0.0001) and mean serum testrosterone levels (1.78 vs. 1.36 ng/ml, p = 0.03), compared with women treated with other AEDs.
LIMITATIONS: Limitations include small number of women in antiepileptic subgroups and a high drop out rate in women who underwent ultrasound and endocrinological investigation
CONCLUSION: Menstrual abnormalities, weight gain, obesity, and PCOS are frequent and significantly higher in WWE receiving valproate, independent of seizure type.

结论:接受丙戊酸盐治疗的印第安女性癫痫病人的月经异常、体重增加、肥胖和多囊性卵巢综合征常见及有意义的增加,与癫痫类型无关。

0

阅读 评论 收藏 转载 喜欢 打印举报/Report
  • 评论加载中,请稍候...
发评论

    发评论

    以上网友发言只代表其个人观点,不代表新浪网的观点或立场。

      

    新浪BLOG意见反馈留言板 电话:4000520066 提示音后按1键(按当地市话标准计费) 欢迎批评指正

    新浪简介 | About Sina | 广告服务 | 联系我们 | 招聘信息 | 网站律师 | SINA English | 会员注册 | 产品答疑

    新浪公司 版权所有