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論文 |
論文
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兼子, 直
概要:
てんかん治療の進歩により,多くのてんかん者が結婚し,挙児を望むようになった｡そこで,妊娠可能てんかん女性の治療基準設定のため,抗てんかん薬(AED)の催奇形性,服薬中に授乳可能か否か,妊娠中におけるてんかん発作頻度変化などの問題を中心に前方
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視的に検討し,以下の結果を得た｡AEDの服薬が規則的であれば80%以上の症例で妊娠中にてんかん発作頻度は変化しない｡AEDは胎盤を通過し,母乳中にも排推される｡奇形はAED多剤併用投与により増加し,催奇形性の強いAED,あるいは危険なAED併用パターンの存在が明らかになった｡パルビツール剤,ベンゾジアゼピン服用中には出産後1週間は授乳を避けたほうがよいが,それ以外のAED服薬は授乳を妨げない｡AEDにより,胎児の発達は遅れるが,生後3年頃までに回復し,服薬てんかん妊婦の子供でも,育児に配慮することにより,身体精神の発達に大きな問題は残らないことが明らかとなった｡
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| 2.
論文 |
論文
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Nakane, Yoshibumi ; Kaneko, Sunao
概要:
The incidences of various complications during pregnancy are not significantlydifferent between epileptic and nonepileptic mothers in the majority of papersso far reported. More than 70 to 80010 of women with epilepsy
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will have no change inseizure frequency, while 5010 will have fewer seizures than before and the remaining patientswill have more seizures during pregnancy provided that their drug compliance isgood. Intrauterine growth, in particular, of head circumference of fetus is delayed.However, this retardation disappears within few years after birth. The risk of congenitalmalformations of the offspring born to treated epileptic mothers is greater than inthe general population. Among risk factors for teratogenesis that had been consideredto date, only antiepileptic drug (AED)-related factors had proved to be significantly relatedto the occurrence of malformations. Among AEDs, methylphenobarbital, valproate,primidone, carbamazepine and phenytoin are teratogenic, particularly when they areused in combination. Follow up EEG of children born to epileptic mothers revealed thatthe incidence of abnormal EEG was 44010, and 28 to 38010 showed epileptiform patterns.Only 7010 of offspring had epileptic seizures. In the offspring without clinical seizuresrevealed that most of the epileptiform patterns disappear after the age 10. Recommendationsconcerning AED therapy during pregnancy are also discussed.
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| 3.
論文 |
論文
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兼子, 直 ; 近藤, 毅 ; 島田, 杉作 ; 大谷, 浩一 ; 平野, 敬之 ; 福島, 裕 ; 佐藤, 時治郎 ; 野村, 雪光 ; 品川, 信良 ; 寺西, 孝司 ; 後藤, 昌司
概要:
服薬てんかん婦人の児に高頻度に認められる奇形発現の機序を解明すべく,1975年から1983年までprospectiveに十分な観察が可能であった児117例を対象に,奇形発現に関連が推定される各種要因を2重指数判別分析,カテゴリカル主成分分析
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などを用い解析した. 妊娠第1期に服薬していた群の15.7%に,非服薬群の13.3%に奇形が認められ,対象例全体としての奇形発現率は15.4%であった.いわゆる大奇形は服薬群にのみ認められ,服薬群中の単剤治療例には奇形児出産はなく,多剤治療例の奇形発現率は18.0%であった. 要因間における関連性の解釈および各種解析結果から,奇形発現に重要な関連が考えられた要因は多剤併用,特にcarbamazepineとvalproic acidの併用,妊娠第1期における発作発来であったが,その他,部分発作(単純,複雑),抗てんかん薬1日当りの投与の量の関連も推定された.
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| 4.
論文 |
論文
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Kaneko, Sunao
概要:
Clinical and basic researches on epilepsy and pregnancy. in particular of antiepilepticdrugs (AEDs) on the fetus and the epileptic mother, and those of pregnancy on the course ofepilepsy were reviewed.The complete control of
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seizures in the pregestational period and regular drug taking are veryimportant for better management of pregnant epileptics with medication, since the seizure frequencyremains mostly unchanged when the patient's compliance is good. If the serum leveldecreases, one must confirm the patient's compliance. Once compliance has been established, thedose should be increased only when seizures occur.Most AEDs cross the placenta and some cause unwanted effects on the embryo, the fetus, orthe newborn.Thus pre-conceptional counselling should ensure that an epileptic embarks upon a pregnancywith her epilepsy well controlled by a minimal dose of AEDs, and adequate answers for the questionsraised by the patient should be given to prevent poor compliance.There is an increased risk of major congenital malformations among the offsprings of womenwith epilepsy, most of whom are on AEDs. Part of this increase is due to exposure to AEDs.Other factors also appear to play an important role. Prevention of malformation can take placebefore the onset of the pregnancy by decreasing the dose of the drug and/or changing from acombination of AEDs to a single drug, since there is a dose-response relation for teratogenesisand a greater occurrence of congenital malformation when the mother receives combined AEDtherapy.An aspect of prenatal growth deficiency that has raised concern is that brain growth may beaffected, producing microcephaly and mild to moderate mental retardation. However, the delayin the physical development of the offspring may be transient. The psychomotor retardationcontinued only through infancy. if they were nursed properly.
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