Contraception

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避孕期抗癫痫治疗

使用VPA的WOCP应至少选用一种有效的避孕方法（preferably user-independent method such as an intrauterine device or implant）或两种方法联用包括屏障方法。当AEDs有变化，就应重新评估避孕措施。 Family planning is important in patients taking AEDs. WOCP on valproate should use at least one efective method of contraception (preferably a user-independent method such as an intrauterine device or implant) or two complementary methods including a barrier method. Toledo M, Mostacci B, Bosak M, Jedrzejzak J, Thomas RH, Salas-Puig J, Biraben A, Schmitz B. Expert opinion: use of valproate in girls and women of childbearing potential with epilepsy: recommendations and alternatives based on a review of the literature and clinical experience-a European perspective. J Neurol. 2020 Apr 1. doi: 10.1007/s00415-020-09809-0. Epub ahead of print. PMID: 32239268.

Contraception

Prevention of CONCEPTION by blocking fertility temporarily, or permanently (STERILIZATION, REPRODUCTIVE). Common means of reversible contraception include NATURAL FAMILY PLANNING METHODS; CONTRACEPTIVE AGENTS; or CONTRACEPTIVE DEVICES.

The prevention of conception or impregnation by the use of devices or drugs or surgery.

Genetic counselling should be considered if one partner has epilepsy,particularly if the partner has idiopathic epilepsy and a positive family history of epilepsy. [2004] 如果其中一方患有癫痫，特别是如果伴侣患有特发性癫痫且有阳性癫痫家族史，则应考虑进行遗传咨询。 [2004] In women and girls of childbearing potential, the risks and benefits of different contraceptive methods, including hormone-releasing IUDs, should be discussed.[2004] 对于具有生育能力的女性，应告知其不同避孕方式的风险与收益，包括激素释放避孕环。 In women of childbearing potential, the possibility of interaction with oral contraceptives should be discussed and an assessment made as to the risks and benefits of treatment with individual drugs.[2004] 对于有怀孕能力的女性（包含治疗可能持续至育龄的未成年女性），需将与口服避孕药的相互作用的可能性及时告知其本人和/或其照料者。同时需对使用了个别药物的治疗方案的风险与益处进行评估。 nice.org.uk/guidance/cg137

Contraception

What are the long-term neurodevelopmental outcomes of exposure to AEDs and maternal seizure in infants born to WWE? 宫内暴露于AEDs对胎儿长期神经发育的影响 [GRADES OF RECOMMENDATION:C] WWE and their partners need to be informed about the possible adverse impact on long-term neurodevelopment of the newborn following in utero exposure to sodium valproate. 【推荐等级：C】应告知WWE及其伴侣，宫内暴露于VPA可能对其长期神经发育产生不利影响。 [GRADES OF RECOMMENDATION:C] Based on limited evidence, in utero exposure to carbamazepine and lamotrigine does not appear to adversely affect neurodevelopment of the offspring. There is very little evidence for levetiracetam and phenytoin. Parents should be informed that evidence on long-term outcomes is based on small numbers of children. 【推荐等级：C】应告知WWE及其伴侣，关于宫内暴露于AEDs产生的长期神经发育结果是基于少数儿童的。有限的证据表示，宫内接触CBZ和LTG似乎不会影响后代神经生长发育；使用LEV和PHT的证据很少。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the risks of congenital malformations in the fetus of pregnant women with epilepsy (WWE) exposed and not exposed to antiepileptic drugs (AEDs)? 宫内暴露于AEDs对胎儿先天畸形的影响 WWE who are planning their pregnancy should have a clinician competent in the management of epilepsy take responsibility for sharing decisions around choice and dose of AEDs, based on the risk to the fetus and control of seizures. 计划怀孕的WWE应由一位临床医生负责处理其癫痫发作、控制AEDs剂量。 [GRADES OF RECOMMENDATION:C] WWE should be reassured that most mothers have normal healthy babies and the risk of congenital malformations is low if they are not exposed to AEDs in the periconception period. 【推荐等级：C】应告知WWE，多数WWE母亲可拥有正常健康的婴儿，如果WWE在围妊娠期不接触AEDs，其后代发生先天畸形的风险很小。 [GRADES OF RECOMMENDATION:B] Women should be informed that the risk of congenital abnormalities in the fetus is dependent on the type, number and dose of AEDs. 【推荐等级：B】应告知WWE，胎儿先天畸形的风险取决于AEDs的类型、数量和剂量。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the effects of induction of labour on WWE and do AEDs affect induction agents? 引产对WWE的影响是什么？AEDs是否会对诱导剂产生影响？ There are no known contraindications to use of any induction agents in WWE taking AEDs. 目前并没有WWE使用引产药物的禁忌证。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the preferred contraceptive choices in WWE and what risks need to be conveyed to help them make informed decisions? WWE避孕方法的选择 The risks of contraceptive failure and the short- and long-term adverse effects of each contraceptive method should be carefully explained to the woman. Effective contraception is extremely important with regard to stabilisation of epilepsy and planning of pregnancy to optimise outcomes. 应向WWE仔细解释避孕失败的风险以及每种避孕方法的短期和长期不良影响。有效的避孕措施对于优化癫痫控制和计划怀孕非常重要。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

Advice on contraception should be given to young women, ideally before they become sexually active. 应向女性癫痫患者提供避孕建议，最好是在其有性生活之前。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

[GRADES OF RECOMMENDATION:C] To minimise the risk of contraceptive failure, a woman using any combined hormonal contraception, or a combined oral contraceptive pill, or a progesterone-only pill should be prescribed an antiepileptic drug that does not induce hepatic enzymes. C级推荐：为避免将避孕失败的风险降到最低，使用联合避孕药、合用多种口服避孕药或仅服用黄体酮避孕药的妇女，应使用非肝酶诱导性AEDs。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

For women with epilepsy not receiving antiepileptic drugs and for those receiving antiepileptic drugs that do not induce hepatic enzymes (other than lamotrigine), contraceptive options are the same as those for women in general. 对于没有接受AEDs治疗或接受非酶诱导AEDs的患者，其避孕选择与一般妇女相同。 [GRADES OF RECOMMENDATION:D] Women with epilepsy who are not taking antiepileptic drugs, or who are taking non-enzyme inducing antiepileptic drugs, including lamotrigine, can use emergency contraception as for the general population. D级推荐：没有服用AEDs的女性癫痫患者或正在服用包括LTG在内的非酶诱导性AEDs的女性癫痫患者，其避孕措施与一般人群相同。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

For most patients, reassurance can be given that, in general, the risk of epilepsy developing in the children of parents with epilepsy is low. 应告知患者，对于大多数癫痫患者而言，其后代患癫痫的风险很低。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

没有充分的证据表明联合使用组合类避孕药有更高的临界频率（指南里说的可能是有效避孕率） The evidence does not point to a higher critical frequency in conjunction with combined hormonal contraceptives。 Mauri Llerda JA, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea JJ, Gomez Alonso J, Mercadé Cerdá JM. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients. Neurologia. 2015 Oct;30(8):510-7. English, Spanish. doi: 10.1016/j.nrl.2014.08.002. Epub 2015 Jan 21. PMID: 25618222.

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