病因与危险因素证(09).ppt

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2018-05-20 发布于四川
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病因与危险因素证(09).ppt

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以SE 为首次癫痫发作脑电图局限性背景活动异常部分继发全身性发作神经影像学检查异常 Novak.G，Risk factors for status epilepticus in children with symptomatic epilpesy. Neurology. 1997; 49(3): 533 1 10 Odds ratio 抗癫痫药物与致畸AEDs and teratogenicity North American AED pregnancy registry: Rate of teratogenicity: n=4274 -LTG 1.8% -VPA 8.6% -PB 12% UK pregnancy registry, n=3000 VPALTGCBZ EURAP pregnancy registry group, n=6500 confounding factors (e.g. maternal age, type of epilepsy, seizure occurrence, family history of malformations, exposure to other teratogens etc). 癫痫孕妇围产期预后前瞻性多因素对照分析（n=179） Epilepsia?47?(1),?186-192.2006 Outcome WWAE (n = 127) Controls (n = 24,778) p OR 95% CI Preterm delivery (37 wk) 5 (3.9%) 1,576 (6.4%) 0.18 0.51 0.19–1.36 Admission to a neonatal unit 17 (13.4%) 1,822 (7.4%) 0.01 1.98 1.17–3.34 Apgar score 7 1 min 14 (11.0%) 1,239 (5.0%) 0.005 2.29 1.29–4.05 5 min 4 (3.2%) ?471 (1.9%) 0.37 1.60 0.58–4.38 Low birth weight 7 (5.5%) 1, 172 (4.7%) 0.96 1.02 0.44–2.35 Small for gestational age 22 (17.3%) 2,291 (9.3%) 0.005 2.16 1.34–3.47 Abnormal FHR during delivery 17 (13.4%) 3,815 (15.4%) 0.57 0.86 0.51–1.44 Fetal distress 7 (5.5%) 738 (3.0%) 0.11 1.88 0.87–4.07 Fetal death 0 103 (0.42%) 1.0a NA OR is adjusted for maternal age 35 years, pregravid body mass index 25kg/m2, and unemployment of the mother. WWAE, women with active epilepsy; OR, odds ratio; CI, confidence interval; FHR, fetal heart rate; NA, not applicable; fetal distress, Apgar at 5 min 7 or fetal venous pH 7.15. TABLE 4.?Major malformations in the children of women with active epilepsy according to the medication used Malformation AED, daily dose FA supplement Seizures in pregnancy SE in pregnancy Comments Spina bifida VPA, 2,000–2,300 mg None One generalized seizure, 3rd trimester No TBC medication Cleft palate CBZ, 1,200–1,600 mg None 15 focal and 10 generalized seizures No Polydactyly CBZ, 800 mg Uncertain None No Aunt with polydactyly