Update to the Hong Kong Epilepsy Guideline: evidence-based recommendations for clinical management of women with epilepsy throughout the reproductive cycle

Abstract

Since the publication of the Hong Kong Epilepsy Guideline in 2009, there has been significant progress in antiepileptic drug development. New AEDs have emerged, and data about their uses have been published. Women require special attention in epilepsy care. Drug teratogenicity, pregnancy, breastfeeding, contraception, reproduction technology, menopause, and catamenial epilepsy are major topics. Antiepileptic drugs should be chosen individually for patients who are pregnant or may become pregnant with consideration of their teratogenicity and seizure control properties. Folate is commonly prescribed for women of childbearing age who are taking antiepileptic drugs. Spontaneous vaginal delivery and breastfeeding are not contra-indicated in most cases but need to be considered individually based on the patient’s medical condition and wishes. Serum drug level monitoring of certain antiepileptic drugs during pregnancy and puerperium can guide dosage adjustment. For catamenial epilepsy, intermittent benzodiazepines such as clobazam during the susceptible phase of the menstrual cycle could be a treatment option.

自2009年發佈香港腦癇指引以來，抗腦癇藥的開發取得重大進展。新 的抗腦癇藥及其用途的數據已被發表。婦女在腦癇治療中需要特別留 意。藥物致畸性、懷孕、母乳喂養、避孕、生殖技術、更年期和月經 期腦癇是重要主題。考慮到其致畸性和腦癇發作控制特性，應為懷孕 或可能懷孕的患者個別選擇抗腦癇藥。葉酸通常用於服用抗腦癇藥的 育齡婦女。大多數情況下，自發陰道分娩和母乳喂養不是禁忌的，但 須根據患者的醫療狀況和意願作個別考慮。在妊娠和產褥期監測某些 抗腦癇藥的血清藥物水平可以指引劑量調整。對於月經性腦癇，在月 經週期的敏感階段間歇使用苯二氮卓類藥物（如氯巴沙姆）可作其中 一種治療選擇。