てんかんをもつ女性のための包括的治療戦略

Comprehensive Management for Women with Epilepsy

はじめに

　女性てんかん患者のための医療は，男性てんかん患者の場合とは大きく異なる^1）。例えば，女性では女性ホルモンの周期的変化に関連して発作の起こりやすさも変化するなど，男性とは異なる生物学的特性が存在する。また，女性では男性にはみられないような心理社会学的問題が出現し得る^2）。

　本稿では，現在わが国で用いられている日本てんかん学会作成『てんかんをもつ妊娠可能年齢の女性に対する治療ガイドライン』^3）と日本神経学会作成『てんかん治療ガイドライン2010』^4）を参考に，女性てんかん患者のための医療に不可欠な知識を整理するとともに，治療戦略についても概説する。

Abstract

　Medical treatment of epilepsy is quite different for women than for men.　It is known that estrogen facilitates while progesterone inhibits the generation of epileptic seizures.　Due to the direct neuronal effects of estrogen,progesterone,and their metabolites,as well as the cyclic nature of sex hormone release,women are particularly susceptible to the effects of these hormones on seizure frequency and severity.　Antiepileptic drugs (AEDs) may result in reproductive endocrine disorders,inhibition of sexuality,decrease in oral contraceptive effects,or congenital malformations.　Results of a systematic literature review suggest that the overall incidence of the congenital malformations in children born to women with epilepsy is approximately three times that of healthy women.　The risk is elevated in all patients receiving AED monotherapy and further elevated in those receiving AED polytherapy compared to women without epilepsy.　Studies have shown that many of these risks can be minimized with appropriate treatment and preconception counseling.　The present review article summarizes the comprehensive management of women with epilepsy from a bio-psycho-socio-ethical point of view.