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Kune vakadzi vezera rekubereka vane pfari, kuchengetedzwa kwemishonga inorwisa-seizure yakakosha kwavari nevana vavo, sezvo mishonga inowanzodiwa panguva yekuzvitakura uye kuyamwisa kuderedza migumisiro yekugumburwa. Kana kukura kwenhengo yefetus kunokanganiswa nekurapwa kwemishonga yekudzivirira chirwere chemimba panguva yekuzvitakura chinhu chinonetsa. Ongororo dzakapfuura dzakaratidza kuti pakati pechinyakare anti-seizure mishonga, valproic acid, phenobarbital, uye carbamazepine inogona kupa teratogenic njodzi. Pakati pemishonga mitsva inorwisa-seizure, lamotrigine inoonekwa seisina kuchengetedzeka kune fetus, nepo topiramate inogona kuwedzera njodzi ye "fetus cleft lip and palate".

Tsvakurudzo dzinoverengeka dzeurourodevelopmental dzakaratidza mubatanidzwa pakati pekushandiswa kwaamai kwevalproic acid panguva yekuzvitakura uye kuderera kwekuziva basa, autism, uye kutarisisa kushomeka kwe hyperactivity disorder (ADHD) muvana. Nekudaro, humbowo hwemhando yepamusoro pahukama pakati pekushandiswa kwaamai topiramate panguva yekuzvitakura uye neurodevelopment yevana inoramba isina kukwana. Nechemumoyo, chidzidzo chitsva chakaburitswa svondo rapfuura muNew England Journal of Medicine (NEJM) inotiunzira humwe humbowo

Munyika chaimo, miyedzo mikuru-yakakura isina kurongeka haigoneki muvakadzi vane nhumbu vane pfari vanoda mishonga yekudzivirira kuti vaongorore kuchengetedzwa kwemishonga. Nekuda kweizvozvo, maregistries epamuviri, zvidzidzo zveboka, uye nyaya-yekudzora zvidzidzo zvave zvakanyanya kushandiswa magadzirirwo ezvidzidzo. Kubva pakuona kwemaitiro, chidzidzo ichi chimwe chezvidzidzo zvemhando yepamusoro zvinogona kuitwa pari zvino. Zvinonyanya kukosha ndezvinotevera: iyo yeruzhinji-yakavakirwa hombe-sample cohort nzira yekudzidza inogamuchirwa. Kunyange zvazvo dhizaini iri retrospective, iyo data inobva kune maviri makuru makuru ehurumende yeUnited States Medicaid uye Medicare masisitimu akanyoreswa kare, saka kuvimbika kwedata kwakakwirira; Iyo yepakati yekutevera nguva yaive makore maviri, ayo aisangana nenguva yaidiwa yekuongororwa kwe autism, uye inoda kusvika gumi muzana (inodarika mazana mana emakumi mana ezviuru) yakateverwa kweanopfuura makore masere.

Chidzidzo ichi chaisanganisira vanopfuura mamiriyoni mana evakadzi vane pamuviri vakakodzera, 28,952 avo vakaonekwa kuti vane pfari. Vakadzi vakaiswa mumapoka maererano nokuti vakanga vachitora antiepileptic zvinodhaka kana zvakasiyana-siyana antiepileptic mishonga mushure memavhiki e19 ekuzvitakura (danho apo synapses inoramba ichiumbwa). Topiramate yakanga iri muboka rakafumurwa, valproic acid yakanga iri muboka rakanaka rekutonga, uye lamotrigine yaiva muboka rekutonga risina kunaka. Boka risingaonekwi rekutonga raisanganisira vakadzi vese vane pamuviri vakanga vasingatore chero mishonga yekurwisa-seizure kubva pamazuva makumi mapfumbamwe vasati vasvika nguva yavo yekupedzisira kusvika panguva yekusununguka (zvakare kusanganisira kusashanda kana kusabatwa kwepfari).

Migumisiro yakaratidza kuti inofungidzirwa kuwedzera chiitiko che autism pazera remakore 8 chaiva 1.89% pakati pevana vose vasina kuratidzwa kune chero mishonga ye antiepileptic; Pakati pevana vakaberekwa naamai vane pfari, kuwanda kwechiitiko che autism kwaiva 4.21% (95% CI, 3.27-5.16) muvana vakanga vasina kutarisana nemishonga inorwisa antiepileptic. The cumulative chiitiko che autism muvana vakafumurwa topiramate, valproate, kana lamotrigine aiva 6.15% (95% CI, 2.98-9.13), 10.51% (95% CI, 6.78-14.24), uye 4.08% (95% 5-7), ruremekedzo.

Zvichienzaniswa ne "fetus" isina kuratidzwa antiseizure zvinodhaka, autism ngozi akagadziridzwa propensity zvibodzwa akanga sezvinotevera: Yaiva 0.96 (95% CI, 0.56 ~ 1.65) mu topiramate exposure boka, 2.67 (95% CI, 1.69 ~ 4.20) muboka valproic, 09 asidhi exposure 51%. 0.69 ~ 1.46) muboka rekuisa lamotrigine. Mukuongorora kweboka rediki, vanyori vakaita mhedziso dzakafanana zvichienderana nekuti varwere vakagamuchira monotherapy, dhigirii rekurapa kwezvinodhaka, uye kana paine hukama hwekuratidzwa kwezvinodhaka pakubata pamuviri kwekutanga.

Zvigumisiro zvakaratidza kuti vana vevakadzi vane pamuviri vane pfari vaiva nengozi yepamusoro ye autism (4.21 muzana). Hapana topiramate kana lamotrigine yakawedzera njodzi yeautism muvana vevanaamai vakatora antiseizure zvinodhaka panguva yekuzvitakura; Zvisinei, apo valproic asidhi yakatorwa panguva yekuzvitakura, pakanga pane dose-inotsamira yakawedzera ngozi autism muvana. Kunyange zvazvo chidzidzo chacho chaingotarisa pamusoro pechiitiko che autism muvana vevakadzi vane pamuviri vanotora mishonga yekudzivirira, uye haina kuvhara zvimwe zvinowanzoitika neurodevelopmental migumisiro yakadai sekuziva kuderera kwevana uye ADHD, ichiri kuratidza hushoma hushoma neurotoxicity ye topiramate muvana kana ichienzaniswa nevalproate.

Topiramate haisati yaonekwa sechinhu chakanaka chinotsiva sodium valproate panguva yekuzvitakura, nekuti inogona kuwedzera njodzi yekutsemuka muromo uye mukanwa uye diki kune gestational age. Pamusoro pezvo, pane zvidzidzo zvinoratidza kuti topiramate inogona kuwedzera njodzi yeurourodevelopmental kusagadzikana muvana. Zvisinei, chidzidzo cheNEJM chinoratidza kuti kana uchingofunga nezvezvinoita neurodevelopment yevana, kune vakadzi vane pamuviri vanoda kushandisa valproate kune anti-epileptic seizures, zvakakosha kuwedzera njodzi yeurourodevelopmental disorders muvana. Topiramate inogona kushandiswa seimwe nzira yekurapa. Zvinofanira kucherechedzwa kuti chikamu chevanhu vekuAsia nevamwe vezvitsuwa zvePacific vari muchikwata chese chakadzikira kwazvo, chinongoverengera 1% chete yeboka rose, uye panogona kunge paine misiyano yemarudzi mukuita kwakashata kune anti-seizure mishonga, saka kana mhedzisiro yechidzidzo ichi inogona kuendeswa zvakananga kuvanhu vekuAsia (kusanganisira vanhu vekuChina) inoda kusimbiswa neruzhinji rwevanhu vekuAsia mune ramangwana rekutsvaga.