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妊娠期癫痫发作频率和抗癫痫治疗的变化
Changes in Seizure Frequency and Antiepileptic Therapy during Pregnancy


Page B. Pennell ... 妇产科和儿科 • 2020.12.24

摘要


背景

女性癫痫患者的妊娠期癫痫发作频率变化情况研究受到限制,原因是缺乏适当的非妊娠对照组来提供两组中癫痫发作频率的自然过程数据。

 

方法

在这项前瞻性、观察性、多中心队列研究中,我们比较了妊娠期(截至围产期,即产后6周)(时期1)的癫痫发作频率和产后期(之后7.5个月)(时期2)的癫痫发作频率。本试验纳入了非妊娠的女性癫痫患者作为对照,她们在18个月期间接受了类似随访。主要结局是在时期1意识受损性癫痫发作频率高于时期2的女性百分比。我们还比较了时期1前9个月期间,两组中抗癫痫药剂量的变化情况。

 

结果

本试验纳入了患癫痫的351名孕妇和109名对照女性。在发生意识受损性癫痫发作,并且两个时期均获得数据的299名孕妇和93名对照女性中,70名孕妇(23%)和23名对照女性(25%)在时期1的癫痫发作频率高于时期2(比值比,0.93;95%置信区间[CI],0.54~1.60)。在时期1(即孕妇妊娠期间),74%孕妇和31%对照女性的抗癫痫药剂量至少变化了1次(比值比,6.36;95% CI,3.82~10.59)。

 

结论

在女性癫痫患者中,妊娠期癫痫发作频率高于产后期的百分比与时期1癫痫发作频率高于时期2的非妊娠女性百分比相似。在相似时间段内,孕妇的抗癫痫药剂量变化频率高于非妊娠女性(由美国国立卫生研究院资助;MONEAD在ClinicalTrials.gov注册号为NCT01730170)。





作者信息

Page B. Pennell, M.D., Jacqueline A. French, M.D., Ryan C. May, Ph.D., Elizabeth Gerard, M.D., Laura Kalayjian, M.D., Patricia Penovich, M.D., Evan Gedzelman, M.D., Jennifer Cavitt, M.D., Sean Hwang, M.D., Alison M. Pack, M.D., Maria Sam, M.D., John W. Miller, M.D., Ph.D., Steffanie H. Wilson, Ph.D., Carrie Brown, M.S., Angela K. Birnbaum, Ph.D., and Kimford J. Meador, M.D. for the MONEAD Study Group*
From Brigham and Women’s Hospital, Harvard Medical School, Boston (P.B.P.); New York University Comprehensive Epilepsy Center (J.A.F.) and Columbia University (A.M.P.), New York, and Northwell Health, Great Neck (S.H.) — both in New York; Emmes, Rockville, MD (R.C.M., S.H.W., C.B.); Northwestern University, Chicago (E. Gerard); the University of Southern California, Los Angeles (L.K.), and Stanford University, Palo Alto (K.J.M.) — both in California; the Minnesota Epilepsy Group, St. Paul (P.P.), and the University of Minnesota, Minneapolis (A.K.B.); Emory University School of Medicine, Atlanta (E. Gedzelman); the University of Cincinnati, Cincinnati (J.C.); Wake Forest University, Winston-Salem, NC (M.S.); and the University of Washington, Seattle (J.W.M.). Address reprint requests to Dr. Pennell at Harvard Medical School, Department of Neurology, Division of Women’s Health, Brigham and Women’s Hospital, 60 Fenwood Rd., Boston, MA 02115, or at ppennell@bwh.harvard.edu. *A complete list of the members of the MONEAD Study Group is provided in the Supplementary Appendix, available at NEJM.org.

 

参考文献

1. Bruno E, Maira G, Biondi A, Richardson MP. Ictal hypoxemia: a systematic review and meta-analysis. Seizure 2018;63:7-13.

2. Christensen J, Vestergaard C, Hammer Bech B. Maternal death in women with epilepsy: smaller scope studies. Neurology 2018;91(18):e1716-e1720.

3. MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol 2015;72:981-988.

4. Edey S, Moran N, Nashef L. SUDEP and epilepsy-related mortality in pregnancy. Epilepsia 2014;55(7):e72-e74.

5. Harden CL, Hopp J, Ting TY, et al. Management issues for women with epilepsy — focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia 2009;50:1229-1236.

6. Pennell PB, Peng L, Newport DJ, et al. Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency. Neurology 2008;70:2130-2136.

7. Petrenaite V, Sabers A, Hansen-Schwartz J. Seizure deterioration in women treated with oxcarbazepine during pregnancy. Epilepsy Res 2009;84:245-249.

8. Sabers A, Petrenaite V. Seizure frequency in pregnant women treated with lamotrigine monotherapy. Epilepsia 2009;50:2163-2166.

9. Reisinger TL, Newman M, Loring DW, Pennell PB, Meador KJ. Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy. Epilepsy Behav 2013;29:13-18.

10. Harden CL, Hopp J, Ting TY, et al. Practice parameter update: management issues for women with epilepsy — focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 2009;73:126-132.

11. Meador KJ, Pennell PB, May RC, et al. Changes in antiepileptic drug-prescribing patterns in pregnant women with epilepsy. Epilepsy Behav 2018;84:10-14.

12. Thomas SV, Syam U, Devi JS. Predictors of seizures during pregnancy in women with epilepsy. Epilepsia 2012;53(5):e85-e88.

13. NINDS common data elements home page. 2020 (https://commondataelements.ninds.nih.gov/. opens in new tab).

14. Dunn L, Dunn D. Peabody Picture Vocabulary Test. 4th ed. Minneapolis: Pearson Assessments, 2007.

15. Cagnetti C, Lattanzi S, Foschi N, Provinciali L, Silvestrini M. Seizure course during pregnancy in catamenial epilepsy. Neurology 2014;83:339-344.

16. First MB, Williams JBW, Spitzer RL, Gibbon M. Structured clinical interview for DSM-IV-TR axis I disorders. Patient ed. Washington, DC: American Psychiatric Publishing, January 2010.

17. Tomson T, Battino D, Bonizzoni E, et al. Declining malformation rates with changed antiepileptic drug prescribing: an observational study. Neurology 2019;93(9):e831-e840.

18. Meador KJ, Baker GA, Browning N, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol 2013;12:244-252.

19. Meador KJ, Baker GA, Browning N, et al. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. N Engl J Med 2009;360:1597-1605.

20. Christensen J, Grønborg TK, Sørensen MJ, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA 2013;309:1696-1703.

21. Petrenaite V, Sabers A, Hansen-Schwartz J. Individual changes in lamotrigine plasma concentrations during pregnancy. Epilepsy Res 2005;65:185-188.

22. EURAP Study Group. Seizure control and treatment in pregnancy: observations from the EURAP epilepsy pregnancy registry. Neurology 2006;66:354-360.

23. Tomson T, Lindbom U, Ekqvist B, Sundqvist A. Epilepsy and pregnancy: a prospective study of seizure control in relation to free and total plasma concentrations of carbamazepine and phenytoin. Epilepsia 1994;35:122-130.

24. Harden CL, Pennell PB, Koppel BS, et al. Practice parameter update: management issues for women with epilepsy — focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 2009;73:142-149.

25. Tomson T, Battino D, Bromley R, et al. Management of epilepsy in pregnancy: a report from the International League Against Epilepsy Task Force on Women and Pregnancy. Epileptic Disord 2019;21:497-517.

26. Tran TA, Leppik IE, Blesi K, Sathanandan ST, Remmel R. Lamotrigine clearance during pregnancy. Neurology 2002;59:251-255.

27. Voinescu PE, Park S, Chen LQ, et al. Antiepileptic drug clearances during pregnancy and clinical implications for women with epilepsy. Neurology 2018;91(13):e1228-e1236.

28. Reimers A, Helde G, Becser Andersen N, et al. Zonisamide serum concentrations during pregnancy. Epilepsy Res 2018;144:25-29.

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