Teratogenicity of antiepileptic medications
Teratogenicity of antiepileptic medications
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DOI：
10.1055/s-2008-1079337
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发表时间：
2008-07-01
影响因子：
2.7
通讯作者：
Meador, Kimford J.
中科院分区：
文献类型：
--
作者：
Kluger, Benzi M.;Meador, Kimford J.
抗癫痫药物（AED）经常用于治疗育龄妇女常见的几种疾病，包括癫痫、头痛和情绪障碍。此外，在癫痫和严重精神疾病的情况下，临床医生往往没有停止这些药物或改用另一类药物的选择。总体而言，AED与儿童期主要先天性畸形、轻微异常、特定先天性综合征和发育障碍的风险增加相关。然而，个体AED的差异效应仍不确定。不断积累的数据强烈表明，这些风险在接受多种药物和丙戊酸盐治疗的患者中最高。也有适度的证据表明苯巴比妥的风险增加。虽然其他较旧的AED似乎具有一些致畸风险，但没有足够的证据来进一步分层其风险。关于新型AED的临床和基础科学研究表明，与老式AED相比，即使不是更安全，也是相当的，但这些数据并不确定。对女性癫痫患者的管理应包括讨论这些风险，叶酸预防性治疗，以及维持最佳癫痫控制所需的最低限度的多药和丙戊酸盐使用。
Antiepileptic drugs (AEDs) are frequently used to treat several conditions that are common in women of childbearing age, including epilepsy, headaches, and mood disorders. Moreover, as in the case of epilepsy and severe psychiatric disease, clinicians frequently do not have the option of stopping these medications or switching to another class of drugs. Overall, AEDs have been associated with an increased risk of major congenital malformations, minor anomalies, specific congenital syndromes, and developmental disorders seen in childhood. However, the differential effects of individual AEDs remain uncertain. Data are accumulating which strongly suggest that these risks are highest in patients receiving polypharmacy and valproate. There is also modest evidence to suggest an increased risk for phenobarbital. While other older AEDs appear to carry some teratogenic risk, there is not adequate evidence to further stratify their risk. Clinical and basic science research regarding newer AEDs suggests equivalent, if not safer, profiles compared with older AEDs, but these data are inconclusive. Management of women with epilepsy should include a discussion of these risks, prophylactic treatment with folic acid, and the minimal use of polypharmacy and valproate needed to maintain optimum seizure control.