平衡胎儿的不利条件和癫痫发作自由妇女怀孕-澳大利亚怀孕登记的经验

IF 2.3 3区医学 Q2 BEHAVIORAL SCIENCES

Epilepsy & Behavior Pub Date : 2025-08-28 DOI:10.1016/j.yebeh.2025.110663

Frank Vajda , Terence J. O’Brien , Janet Graham , Alison Hitchcock , Piero Perucca , Cecilie Lander , Mervyn Eadie

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引用次数: 0

摘要

目的确定哪种抗癫痫药物（asm）在降低胎儿畸形风险和持续控制妊娠期间母体癫痫之间提供了最佳的整体折衷。方法对女性服用5种最常用的抗抑郁药(左乙拉西坦（LEV）、拉莫三嗪（LTG）、卡马西平（CBZ）的相关数据进行分析。Raoul Wallenberg Australian妊娠登记抗癫痫药物（APR）中2403例癫痫（WWE）孕妇的托吡酯（TPM）和丙戊酸（VPA）。结果slev在胎儿畸形低风险方面优势最大，其次是LTG，其次是CBZ，最后是VPA。对于维持妊娠期间癫痫发作自由，丙戊酸钠（VPA）效果最好，其次是LEV和CBZ，最后是LTG。当这些权重相等的个人排名组合在一起时，LEV得分最高，其次是VPA，然后是LTG和CBZ（相同）。然而，如果避免胎儿畸形的权重更大，则顺序为LEV，其次是LTG和CBZ，最后是VPA。TPM对所有评估标准的评价都很差。总体而言，LEV似乎是研究人群中最有利的ASM，平衡了胎儿畸形的风险和维持癫痫控制的机会。这一结果与处方者的行为大致一致，主要是由当代澳大利亚实践中的试错经验决定的。

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Balancing foetal disadvantage and seizure freedom in women capable of pregnancy – the Australian pregnancy register experience

Objective

To determine which antiseizure medications (ASMs) provide the best overall compromise between a lower risk of foetal malformation and continuing control of maternal epilepsy during pregnancy.

Methods

Analysis of relevant data on women taking one of the 5 most commonly prescribed ASMs (levetiracetam (LEV), lamotrigine (LTG), carbamazepine (CBZ). Topiramate (TPM) and valproate (VPA)) in 2403 pregnancies of women with epilepsy (WWE) contained in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs (APR).

Results

LEV offered the greatest advantage with regard to low risk of foetal malformation, followed by LTG, then CBZ and then VPA. In relation to preserving seizure freedom throughout pregnancy valproate (VPA) was best, followed by LEV and CBZ, then LTG. When these individual rankings, equally weighted, were combined, LEV scored highest, followed by VPA and then LTG and CBZ (equal). However, if avoiding foetal malformation was weighted more heavily, the sequence became LEV, then LTG and CBZ, and then VPA. TPM rated poorly to all criteria assessed.

Significance

Overall, LEV appeared the most advantageous ASM to employ in the population studied, balancing the risk of foetal malformations with the chance of maintaining seizure control. This outcome is broadly in conformity with prescriber behaviour determined largely by trial-and-error experience in contemporary Australian practice.

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来源期刊

Epilepsy & Behavior 医学-行为科学

CiteScore

5.40

自引率

15.40%

发文量

385

审稿时长

43 days

期刊介绍： Epilepsy & Behavior is the fastest-growing international journal uniquely devoted to the rapid dissemination of the most current information available on the behavioral aspects of seizures and epilepsy. Epilepsy & Behavior presents original peer-reviewed articles based on laboratory and clinical research. Topics are drawn from a variety of fields, including clinical neurology, neurosurgery, neuropsychiatry, neuropsychology, neurophysiology, neuropharmacology, and neuroimaging. From September 2012 Epilepsy & Behavior stopped accepting Case Reports for publication in the journal. From this date authors who submit to Epilepsy & Behavior will be offered a transfer or asked to resubmit their Case Reports to its new sister journal, Epilepsy & Behavior Case Reports.