nkhani

Kwa amayi a msinkhu wobereka omwe ali ndi khunyu, chitetezo cha mankhwala oletsa kugwidwa ndi kofunika kwambiri kwa iwo ndi ana awo, chifukwa mankhwala nthawi zambiri amafunikira panthawi yomwe ali ndi pakati ndi kuyamwitsa kuti achepetse zotsatira za khunyu. Kaya kukula kwa chiwalo cha fetal kumakhudzidwa ndi chithandizo chamankhwala a antiepileptic panthawi yomwe ali ndi pakati ndizodetsa nkhawa. Kafukufuku wam'mbuyomu wasonyeza kuti pakati pa mankhwala achikhalidwe odana ndi khunyu, valproic acid, phenobarbital, ndi carbamazepine atha kukhala ndi chiopsezo cha teratogenic. Pakati pa mankhwala atsopano oletsa khunyu, lamotrigine amaonedwa kuti ndi otetezeka kwa mwana wosabadwayo, pamene topiramate ingapangitse chiopsezo cha fetal cleft mlomo ndi mkamwa.

Maphunziro angapo a neurodevelopmental awonetsa mgwirizano pakati pa kugwiritsa ntchito kwa amayi kwa valproic acid panthawi yomwe ali ndi pakati komanso kuchepa kwa chidziwitso, autism, komanso vuto la chidwi chambiri (ADHD) mwa ana. Komabe, umboni wapamwamba kwambiri wokhudzana ndi kugwiritsiridwa ntchito kwa topiramate kwa amayi pa nthawi ya mimba ndi chitukuko cha ana sichikwanira. Mwamwayi, kafukufuku watsopano yemwe adasindikizidwa sabata yatha mu New England Journal of Medicine (NEJM) akutibweretsera umboni wochulukirapo

M'dziko lenileni, mayesero akuluakulu oyendetsedwa mwachisawawa sangatheke kwa amayi apakati omwe ali ndi khunyu omwe amafunikira mankhwala oletsa kugwidwa kuti afufuze chitetezo cha mankhwala. Zotsatira zake, zolembera zokhala ndi pakati, maphunziro apagulu, ndi maphunziro owongolera milandu akhala njira zophunzirira zomwe zimagwiritsidwa ntchito kwambiri. Kuchokera pamawonedwe a methodological, phunziro ili ndi limodzi mwa maphunziro apamwamba omwe angagwiritsidwe ntchito pakalipano. Mfundo zazikuluzikulu zake ndi izi: njira yophunzirira magulu akuluakulu a anthu amatengedwa. Ngakhale kuti mapangidwewa ndi obwerezabwereza, deta imachokera kuzinthu ziwiri zazikulu za dziko la US Medicaid ndi Medicare machitidwe omwe adalembedwa kale, kotero kuti kudalirika kwa deta kuli kwakukulu; Nthawi yotsatiridwa yapakatikati inali zaka 2, zomwe zidakwaniritsa nthawi yofunikira kuti adziwe matenda a autism, ndipo pafupifupi 10% (zoposa 400,000 milandu yonse) adatsatiridwa kwa zaka zoposa 8.

Kafukufukuyu adaphatikizapo amayi oyembekezera opitilira 4 miliyoni, 28,952 omwe adapezeka ndi khunyu. Azimayi adayikidwa m'magulu molingana ndi momwe amamwa mankhwala oletsa khunyu kapena mankhwala ena a antiepileptic pambuyo pa masabata 19 oyembekezera (nthawi yomwe ma synapses akupitiriza kupanga). Topiramate anali mu gulu lowonekera, valproic acid anali mu gulu lolamulira labwino, ndipo lamotrigine anali m'gulu lolamulira loipa. Gulu lolamulira losadziwika linaphatikizapo amayi onse apakati omwe sankamwa mankhwala oletsa kugwidwa kuchokera masiku 90 asanafike nthawi yawo yomaliza ya kusamba mpaka nthawi yobereka (kuphatikizapo khunyu yosagwira ntchito kapena yosachiritsika).

Zotsatira zinawonetsa kuti kuchuluka kwa matenda a autism ali ndi zaka 8 kunali 1.89% mwa ana onse omwe sanakumanepo ndi mankhwala oletsa khunyu; Pakati pa ana obadwa kwa amayi omwe ali ndi khunyu, kuchuluka kwa autism kunali 4.21% (95% CI, 3.27-5.16) mwa ana omwe sanakumanepo ndi mankhwala oletsa khunyu. Kuchulukirachulukira kwa autism mwa ana omwe amakumana ndi topiramate, valproate, kapena lamotrigine anali 6.15% (95% CI, 2.98-9.13), 10.51% (95% CI, 6.78-14.24), ndi 4.08% (95% 5-5), motsatana.

Poyerekeza ndi ana osabadwa omwe sanawonekere ku mankhwala oletsa kugwidwa, chiopsezo cha autism chosinthidwa kuti chikhale chotsatira chinali motere: Anali 0.96 (95% CI, 0.56 ~ 1.65) mu gulu la topiramate exposure, 2.67 (95% CI, 1.69 ~ 4.20) mu gulu la valproic, 51% exposure, CI9 ndi 51% exposure. 0.69 ~ 1.46) mu gulu lamotrigine exposure. Pakuwunika kwamagulu ang'onoang'ono, olembawo adapeza malingaliro ofanana potengera ngati odwala adalandira monotherapy, mlingo wa mankhwala osokoneza bongo, komanso ngati panali kukhudzana ndi mankhwala okhudzana ndi mimba yoyambirira.

Zotsatira zinawonetsa kuti ana a amayi apakati omwe ali ndi khunyu anali ndi chiopsezo chachikulu cha autism (4.21 peresenti). Ngakhale topiramate kapena lamotrigine sichinawonjezere chiopsezo cha autism mwa ana a amayi omwe amamwa mankhwala osokoneza bongo pa nthawi ya mimba; Komabe, pamene valproic asidi anatengedwa pa mimba, panali mlingo amadalira kuchuluka kwa chiopsezo cha autism mwa ana. Ngakhale kuti kafukufukuyu anangoyang'ana pa zochitika za autism mwa ana a amayi apakati omwe amamwa mankhwala oletsa kugwidwa, ndipo sanafotokoze zotsatira zina zodziwika bwino za neurodevelopmental monga kuchepa kwa chidziwitso kwa ana ndi ADHD, zimangowonetsabe kufooka kwa neurotoxicity ya topiramate mwa ana poyerekeza ndi valproate.

Topiramate nthawi zambiri saganiziridwa kuti ndi yabwino m'malo mwa sodium valproate pa nthawi ya mimba, chifukwa ikhoza kuonjezera chiopsezo cha kung'ambika kwa milomo ndi mkamwa komanso yaying'ono pa msinkhu wa gestational. Kuphatikiza apo, pali kafukufuku wosonyeza kuti topiramate ikhoza kuonjezera chiopsezo cha matenda a neurodevelopmental mwa ana. Komabe, kafukufuku wa NEJM akusonyeza kuti ngati kuganizira zotsatira za neurodevelopment wa ana, kwa amayi apakati amene ayenera kugwiritsa ntchito valproate odana khunyu khunyu, m`pofunika kuonjezera chiopsezo neurodevelopmental matenda ana. Topiramate ingagwiritsidwe ntchito ngati mankhwala ena. Zindikirani kuti kuchuluka kwa anthu akuzilumba za ku Asia ndi zilumba zina za Pacific mgulu lonselo ndi otsika kwambiri, kuwerengera 1% yokha ya gulu lonselo, ndipo pangakhale kusiyana kwamitundu pamachitidwe odana ndi kulanda, kotero ngati zotsatira za kafukufukuyu zitha kuperekedwa mwachindunji kwa anthu aku Asia (kuphatikiza anthu aku China) ziyenera kutsimikiziridwa ndi zotsatira za kafukufuku wamtsogolo wa anthu aku Asia.