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Abstract：
Over the past 50 years, published studies have provided quantitative data on the control of epileptic seizures during pregnancy. The studies have varied in quality, and particularly in the ways in which seizure control has been assessed. However, most studies have shown that seizure occurrence rates are more likely to worsen than improve during pregnancy, though in most pregnancies the rates have been unaltered. Nearly all of the studies have involved women with antiseizure medication-treated epilepsy, but there is a little evidence that seizure control also tends to worsen in pregnancies of women with untreated epilepsy. The factors likely to contribute to the seizure worsening are (i) patient non-compliance, (ii) increased antiseizure medication clearance during pregnancy resulting in lower circulating drug concentrations relative to dose, (iii) the effects of the higher female sex hormone levels during pregnancy, oestrogens being pro-epileptogenic and progesterone anti-epileptogenic, and (iv) reluctance to use the potential teratogen valproate in women capable of pregnancy, depriving them of the most effective drug for certain types of epilepsy. Compliance can be encouraged, but at the present time only one other factor is readily correctable, i.e. the increased drug clearance. This can be compensated for by raising antiseizure medication dosage during pregnancy, guided by measurement of circulating drug concentrations. This course of action appears to reduce the chance of seizure disorder worsening during pregnancy, but so far it has not provided a complete solution to the issue.
摘要：
在过去的50年里,已发表的研究提供了有关妊娠期癫痫发作控制的定量数据。这些研究的质量各不相同，特别是在评估癫痫发作控制的方式上。然而,大多数研究表明，怀孕期间癫痫发作发生率更有可能恶化而不是改善，尽管在大多数怀孕中，比率没有改变。几乎所有的研究都涉及患有抗癫痫药物治疗的癫痫的女性，但有一些证据表明，癫痫发作控制也倾向于恶化怀孕的妇女未经治疗的癫痫。可能导致癫痫发作恶化的因素是(I)患者不依从性，（ii）在怀孕期间增加抗癫痫药物清除率，导致相对于剂量较低的循环药物浓度，（iii）怀孕期间女性性激素水平较高的影响，雌激素是诱发癫痫的，孕酮是抗癫痫的，和（iv）不愿意在能够怀孕的妇女中使用潜在的丙戊酸致畸剂，剥夺他们对某些类型的癫痫最有效的药物。可以鼓励合规，但目前只有另一个因素是容易纠正的，即增加的药物清除率。这可以通过在怀孕期间增加抗癫痫药物剂量来补偿，以循环药物浓度测量为导向。这种做法似乎减少了怀孕期间癫痫发作恶化的机会，但到目前为止，它还没有提供一个完整的解决方案。
