女性癫痫-江滢.pptVIP

女 性 癫 痫 江 滢 中山大学附属第三医院 流行病学 Prevalence Incidence Prevalence Prevalence is higher in males than females in 16 of 29 door-to- door studies and 11 of 16 record-review studies for which data was provided. However, absolute difference in gender-specific prevalence is minimal. The most extreme example of a male excess was reported in a study conducted in India, in which prevalence of males (5.1 per 1000) was significantly higher than females (2.2 per 100) (Bharucha et al., 1988). In this population, women with epilepsy are felt to be unmarriageable and this may have led to active concealment of symptoms or diagnosis among women. Prevalence Recent estimates of the U.S. population (U.S. Department of Health and Human Services, 2007) and the prevalence of epilepsy (Hirtz et al., 2007) indicate that approximately one-half million women with epilepsy (WWE) are of childbearing age. Incidence Many studies report a higher incidence in males than females but seldom has this difference been significant (Hauser et al., 1993). Cumulative incidence for all unprovoked seizures reported in Iceland and US demonstrated a significant male excess (Hauser et al., 1993; Olafsson et al., 2005). 婚育状况 结婚率 妊娠率 低生育力的原因 性功能障碍 结婚率 癫痫妇女的结婚率比一般妇女低 Schupf等调查1558例特发性癫痫成人患者，其中960例为女性患者，以她们未患病的同胞姐妹203例为对照组，发现癫痫组结婚率明显低于对照组，分别是60.4%和84.7%，发病年龄越早结婚率越低，＜10岁发病者，结婚率仅44.8%。 妊娠率 癫痫组与对照组的妊娠率分别是61.1%和85.2%，＜10岁发病者妊娠率仅46.8%。 Childbearing rates are 16.9–22.5 per 1000 in WWE compared with 67.6 per 1000 in women without epilepsy. The lower marriage rate of WWE does not fully explain this difference. 低生育力的原因 女性癫痫患者的生育能力亦较非癫痫女性为低，其原因可能是多方面的： 1. 与癫痫发作类型、发作情况及癫痫灶的部位有关，由于其可直接或间接影响到垂体及丘脑下部等，引起月经紊乱，出现无排卵性月经周期。 2. AED影响到丘脑下部-垂体-性腺轴的功能，长期服用丙戊酸的妇女可发生多囊卵巢。 3. 癫痫患者社会心理因素亦十分重要，多数女性癫痫患者不愿受孕，害怕胎儿畸形、癫痫遗传及经济负担等。 低生育力的原因 长久以来，人们普遍认为女性癫痫患者不宜结婚生育。这种错误的观点多半是由于对癫痫病的不了解，包括： (1)癫痫病会遗传给下一代； (2) 抗癫痫药物会导致胎儿畸形； (3) 癫痫病人会行为失控，不适合生儿育女。 性功能障碍 癫痫患者的性功能失调率较非癫痫者高，据Morrell等(1996) 的调查，在美国女性癫痫患者中性功能失调发生率为36%～50% ，北欧为29%，埃及为