女性癫痫患者的管理专家讲稿ppt课件.pptx
《女性癫痫患者的管理专家讲稿ppt课件.pptx》由会员分享,可在线阅读,更多相关《女性癫痫患者的管理专家讲稿ppt课件.pptx(27页珍藏版)》请在三一办公上搜索。
1、女性癫痫患者的长程管理,CH/KP/1606/0163,我国癫痫患病率高达7,约有900万癫痫患者1其中近一半为女性患者23%的癫痫病人为育龄期女性(12-50岁)2,中华神经科杂志. 2013; 46(7): 496-499Joint Epilepsy Council of the UK and Ireland (2011),女性癫痫概述,女性癫痫患者需要更多关注,中华神经科杂志. 2013; 46(7): 496-499,EMA有关VPA的黑框警告,CEA-ILAE 2015指南更新,女性癫痫患者的药物治疗,女性癫痫患者的管理,EMA有关丙戊酸(VPA)在具生育潜力女性(包括女童,女性青少
2、年,育龄期及怀孕女性)中使用的黑框警告,“ VPA*不应用于女性儿童、女性青少年、具生育潜力的女性以及怀孕的女性,除非其他治疗均无效或不耐受。”,4.4.1 Special warnings,Female children/Female adolescents/Women of childbearing potential/Pregnancy: Epilim should not be used in female children, in female adolescents, in women of childbearing potential and pregnant women unl
3、ess alternative treatments are ineffective or not tolerated because of its high teratogenic potential and risk of developmental disorders in infants exposed in utero to valproate. The benefit and risk should be carefully reconsidered at regular treatment reviews, at puberty and urgently when a woman
4、 of childbearing potential treated with Epilim plans a pregnancy or if she becomes pregnant. Women of childbearing potential must use effective contraception during treatment and be informed of the risks associated with the use of Epilim during pregnancy (see section 4.6). The prescriber must ensure
5、 that the patient is provided with comprehensive information on the risks alongside relevant materials, such as a patient information booklet, to support her understanding of the risks. In particular the prescriber must ensure the patient understands: The nature and the magnitude of the risks of exp
6、osure during pregnancy, in particular the teratogenic risks and the risks of developmental disorders. The need to use effective contraception. The need for regular review of treatment. The need to rapidly consult her physician if she is thinking of becoming pregnant or there is a possibility of preg
7、nancy. In women planning to become pregnant all efforts should be made to switch to appropriate alternative treatment prior to conception, if possible (see section 4.6). Valproate therapy should only be continued after a reassessment of the benefits and risks of the treatment with valproate for the
8、patient by a physician experienced in the management of epilepsy.,http:/www.medicines.org.uk/emc/medicine/26124#CLINICAL_PRECAUTIONS,欧洲药品管理局(EMA) 2015年更新的 VPA* SmPC:,EMA:European Medicines AgencySmPC:Summaries of Product Characteristics,胎儿先天畸形影响出生后认知能力发展增加出生后自闭症风险,黑框警告主要基于以下三方面证据,VPA宫内暴露可能导致,一、VPA的胎
9、儿致畸率高,三项大型前瞻性抗癫痫药物与怀孕登记研究 (Uklre, NAAPR 和 EURAP)两项基于人群的研究(NMBR 和 SMBR),VPA: 4.7 9.7% 致畸率,另有一meta分析1显示为 10.7%,Meador et al. Epilepsy Res (2008) ;81:113Tomson et al.Epilepsia (2015). 56(7): 1006-1019.,注:母亲为癫痫患者的致畸率为 7.1%;普通人群的致畸率 为2.1 2.9%,二、胎儿期 VPA 暴露阻碍出生后认知能力的发展,In the prospective “Neurodevelopmenta
10、l Effects of Antiepileptic Drugs” (NEAD) study, IQ at age 6 was on average 811 points lower in valproate-exposed children compared with children exposed to other AEDs (CZP, LTG, phenytoin). These IQ reductions were considered sufficient to affect education and occupational outcomes in later life.NEA
11、D 研究发现,宫内VPA 暴露患儿,6岁时IQ比其他AED(CZP, LTG, PHT) 低8-11分,IQ降低足以造成未来教育和就业的影响Meador KJ, Baker GA, Browning N, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol 2013;12:244252.,When considering lower doses of VPA, in
12、 the two largest prospective studies, IQ at age 6 among children exposed to valproate at doses below 1,000 mg daily or 800 mg daily was comparable to the IQ of children exposed to other AEDs. In the latter study, however, children exposed to valproate 800 mg daily had significantly increased need fo
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 女性 癫痫 患者 管理 专家 讲稿 ppt 课件

链接地址:https://www.31ppt.com/p-1748746.html