nūhou

No nā wāhine o nā makahiki hānau me ka epilepsy, he mea koʻikoʻi ka palekana o nā lāʻau anti-seizure no lākou a me kā lākou mau keiki, no ka mea, koi pinepine ʻia ka lāʻau i ka wā hāpai a me ka hānai ʻana e hōʻemi i ka hopena o ka hopu ʻana. ʻO ka hoʻomohala ʻana o ke kino fetal e pili ana i ka mālama ʻana i ka lāʻau antiepileptic makuahine i ka wā hāpai. Ua hōʻike ʻia nā haʻawina i hala ma waena o nā lāʻau anti-seizure kuʻuna, valproic acid, phenobarbital, a me ka carbamazepine hiki ke loaʻa i nā hopena teratogenic. Ma waena o nā lāʻau anti-seizure hou, ua manaʻo ʻia ʻo lamotrigine he palekana no ka pēpē, ʻoiai ʻo topiramate hiki ke hoʻonui i ka pilikia o ka lehelehe maʻa a me ka palate.

Ua hōʻike kekahi mau noiʻi neurodevelopmental i kahi pilina ma waena o ka hoʻohana ʻana o ka makuahine i ka waika valproic i ka wā hāpai a me ka emi ʻana o ka hana cognitive, autism, a me ka nānā ʻana i ka maʻi hyperactivity deficit (ADHD) i nā keiki. Eia naʻe, ʻaʻole lawa nā hōʻike kiʻekiʻe e pili ana i ka pilina ma waena o ka hoʻohana ʻana i ka topiramate makuahine i ka wā hāpai a me ka neurodevelopment o nā keiki. Mahalo, kahi noiʻi hou i paʻi ʻia i ka pule i hala ma ka New England Journal of Medicine (NEJM) e lawe mai iā mākou i nā hōʻike hou aʻe

Ma ka honua maoli, ʻaʻole hiki ke hoʻāʻo ʻia i nā wahine hāpai me ka epilepsy e pono ai nā lāʻau antiseizure e noiʻi i ka palekana o nā lāʻau. ʻO ka hopena, ua lilo nā hoʻopaʻa inoa o ka hāpai ʻana, nā haʻawina cohort, a me nā haʻawina hoʻokele hihia i nā hoʻolālā noiʻi maʻamau. Mai kahi manaʻo o ka ʻike, ʻo kēia haʻawina kekahi o nā haʻawina kiʻekiʻe e hiki ke hoʻokō ʻia i kēia manawa. ʻO kāna mau mea koʻikoʻi penei: ua apono ʻia ke ʻano noiʻi cohort ma muli o ka heluna kanaka. ʻOiai ka hoʻolālā ʻana he retrospective, loaʻa mai ka ʻikepili mai ʻelua mau waihona ʻāina nui o ka US Medicaid a me nā ʻōnaehana Medicare i hoʻopaʻa inoa ʻia ma mua, no laila ua kiʻekiʻe ka hilinaʻi ʻikepili; ʻO ka manawa maʻamau ka hahai ʻana he 2 mau makahiki, ʻo ia ka mea i hoʻokō pono i ka manawa i koi ʻia no ka maʻi autism, a kokoke i 10% (ʻoi aku ma mua o 400,000 mau hihia i ka huina) i ukali ʻia ma mua o 8 mau makahiki.

Ua komo ka haʻawina ma mua o 4 miliona mau wahine hāpai kūpono, 28,952 o lākou i loaʻa i ka epilepsy. Ua hui pū ʻia nā wahine e like me ka lawe ʻana i nā lāʻau antiepileptic a i ʻole nā ​​​​lāʻau antiepileptic ʻē aʻe ma hope o 19 mau pule o ka hāpai ʻana (ke kahua e hoʻomau ʻia ai nā synapses). ʻO Topiramate i loko o ka hui i hōʻikeʻia, aia ka waika valproic i ka hui mana maikaʻi, aʻo ka lamotrigine i loko o ka pūʻulu manaʻino. ʻO ka pūʻulu hoʻomalu i hōʻike ʻole ʻia, ʻo ia nā wahine hāpai a pau ʻaʻole i lawe i nā lāʻau anti-seizure mai 90 mau lā ma mua o ko lākou manawa menstrual hope a hiki i ka manawa o ka hānau ʻana (me ka epilepsy hoʻomaʻamaʻa ʻole a mālama ʻole ʻia).

Ua hōʻike ʻia nā hopena i ka helu ʻana o ka nui o ka autism i ka makahiki 8 he 1.89% ma waena o nā ʻohana āpau i ʻike ʻole ʻia i nā lāʻau antiepileptic; Ma waena o nā keiki i hānau ʻia i nā makuahine epileptic, ʻo ka cumulative incidence o autism he 4.21% (95% CI, 3.27-5.16) i nā keiki i ʻike ʻole ʻia i nā lāʻau antiepileptic. ʻO ka huina o ka autism ma nā keiki i hōʻike ʻia i ka topiramate, valproate, a i ʻole lamotrigine he 6.15% (95% CI, 2.98-9.13), 10.51% (95% CI, 6.78-14.24), a me 4.08% (95% CI, 2.7), kēlā me kēia.

Hoʻohālikelike ʻia me nā fetuses ʻaʻole i hōʻike ʻia i nā lāʻau antiseizure, ua hoʻoponopono ʻia ka pilikia autism no nā helu propensity penei: ʻO 0.96 (95% CI, 0.56 ~ 1.65) i ka hui hōʻike topiramate, 2.67 (95% CI, 1.69 ~ 4.20) i ka hui hōʻike valproic acid, a me 9. 0.69 ~ 1.46) i ka hui hōʻike lamotrigine. Ma kahi hōʻuluʻulu pūʻulu, ua huki nā mea kākau i nā manaʻo like e pili ana i ka loaʻa ʻana o ka monotherapy i nā maʻi, ka nui o ka lāʻau lapaʻau, a inā paha i pili ka lāʻau lapaʻau i ka wā hāpai mua.

Ua hōʻike ʻia nā hopena i nā keiki a nā wahine hāpai me ka epilepsy i ʻoi aku ka nui o ka autism (4.21 pakeneka). ʻAʻole i hoʻonui ka topiramate a me ka lamotrigine i ka pilikia o ka autism i nā keiki a nā makuahine i lawe i nā lāʻau antiseizure i ka wā hāpai; Eia nō naʻe, i ka wā i lawe ʻia ai ka waika valproic i ka wā hāpai, aia ka nui o ka pilikia o ka autism i loko o nā keiki. ʻOiai ua nānā wale ka haʻawina i ka hopena o ka autism i nā keiki o nā wahine hāpai e lawe ana i nā lāʻau antiseizure, a ʻaʻole i uhi i nā hopena neurodevelopmental maʻamau e like me ka emi ʻana o ka cognitive i nā keiki a me ADHD, ke hōʻike mau nei ia i ka neurotoxicity nāwaliwali o ka topiramate i nā keiki i hoʻohālikelike ʻia me valproate.

ʻAʻole manaʻo ʻia ʻo Topiramate he mea hoʻololi maikaʻi no ka sodium valproate i ka wā hāpai, no ka mea hiki ke hoʻonui i ka pilikia o ka ʻāʻī a me ka palate a me ka liʻiliʻi no ka makahiki hāpai. Eia kekahi, aia nā haʻawina e hōʻike ana e hiki i ka topiramate ke hoʻonui i ka pilikia o nā maʻi neurodevelopmental i nā keiki. Eia naʻe, hōʻike ka haʻawina NEJM inā e noʻonoʻo wale i ka hopena ma ka neurodevelopment o nā keiki, no nā wahine hāpai e pono e hoʻohana i ka valproate no ka hoʻopiʻi anti-epileptic, pono e hoʻonui i ka pilikia o nā maʻi neurodevelopmental i nā keiki. Hiki ke hoʻohana ʻia ka Topiramate ma ke ʻano he lāʻau lapaʻau ʻē aʻe. Pono e hoʻomaopopo ʻia he haʻahaʻa loa ka hapa o ka poʻe ʻAsia a me nā mokupuni ʻē aʻe o ka Pākīpika ma ka hui holoʻokoʻa, ʻo ka helu wale nō 1% o ka hui holoʻokoʻa, a aia paha nā ʻokoʻa lāhui i nā hopena ʻino i nā lāʻau anti-seizure, no laila inā hiki ke hoʻonui pololei ʻia nā hopena o kēia noiʻi i nā poʻe ʻAsia (me ka poʻe Kina) pono e hōʻoia ʻia e nā hopena noiʻi hou aʻe o ka poʻe ʻAsia.