3 0 0 0 OA VI.てんかんと妊娠
- 著者
- 溝渕 雅広 濵内 朗子 佐光 一也
- 出版者
- 一般社団法人 日本内科学会
- 雑誌
- 日本内科学会雑誌 (ISSN:00215384)
- 巻号頁・発行日
- vol.105, no.8, pp.1388-1394, 2016-08-10 (Released:2017-08-10)
- 参考文献数
- 15
妊娠適齢期の女性に対する抗てんかん薬治療で注意することは,1)結婚以前から催奇性を含めた情報を伝える,2)挙児希望するときは早期から投薬の調整を行う,3)安全な妊娠の継続・出産ができるよう発作の抑制に留意し,産科医と連携する,4)母乳の授乳は可能である,5)催奇性,低IQ(intelligence quotient)児・自閉症スペクトラム障害の頻度が増加するため,できる限りバルプロ酸は避ける,6)産後うつに注意し,周囲の協力を助言する.
2 0 0 0 IR TVアニメーションによりけいれん発作が誘発された症例の臨床的特徴
- 著者
- 溝渕 雅広 田中 千春 佐光 一也 村上 宣人 仁平 敦子 阿部 剛典
- 出版者
- 中村記念病院
- 雑誌
- 北海道脳神経疾患研究所医誌 = Journal of Hokkaido Brain Research Foundation (ISSN:13405764)
- 巻号頁・発行日
- vol.10, no.1, pp.33-36, 1999-08-20
We described the clinical features of four cases who had "Pokemon" (television animation program) -induced seizures. Two cases showed photoparoxysmal response (PPR) during intermittent photic stimulation (IPS) and no spike discharges at rest on electroencephalography (EEG). One case had seizures with visual auras and showed spike discharges on the regions of bilateral occipital lobes at rest but no PPR. The last case had generalized tonic clonic seizures and showed bilateral synchronous generalized spikes and slow waves at rest without PPR during IPS. Therefore, the former two cases were recognized as situation-related seizures, and the remaining two cases were recognized as symptomatic occipital lobe epilepsy and idiopathic generalized epilepsy. These cases indicated that seizures were strongly provoked by red and blue flashing stimulation alternating at a frequency of 12 Hz rather than IPS.
1 0 0 0 OA 新ガイドラインを踏まえたてんかんの標準的治療と新規治療
- 著者
- 溝渕 雅広
- 出版者
- 日本神経治療学会
- 雑誌
- 神経治療学 (ISSN:09168443)
- 巻号頁・発行日
- vol.36, no.4, pp.345-348, 2019 (Released:2020-04-24)
- 参考文献数
- 6
The new guideline for epilepsy entitled “The clinical practice guidelines for epilepsy 2018” (Guideline 2018) was published in 2018, it updated “The clinical guidelines for the treatment of epilepsy in 2010”, aiming at standard treatments of epilepsy for all clinicians who treat epilepsy patients even if not epileptologists. The guidelines consist of two parts, the first part including the various summary of diagnosis, medical and surgical therapy, related conditions such as the status epilepticus, the psychogenic non epileptic seizures and the acute symptomatic seizures, the information providing for epilepsy patients. Second part includes systematic reviews prepared by GRADE system.The major points of updated medical treatments are as follows : (1) Although the timing of initiation of therapy is basically after two unprovoked seizures, it may start in cases of neurological abnormality, abnormal finding of EEG, epileptogenic lesion of neuroimages, family history or elder patients. It can also start according to the social status or the willing of patients. (2) The first line treatment of generalized tonic–clonic seizures is sodium valproate, other new drugs such as lamotrigine and levetiracetam are recommended in women fitting the child–bearing age. The first line treatments of focal onset seizures are carbamazepine, lamotrigine and levetiracetam, following zonisamide and topiramate. Second line treatments for focal onset seizures are other drugs including gabapentin, lacosamide and perampanel. (3) In the elder patients with co–mobidity, lamotrigine, levetiracetam and gabapentin are recommended. In women fitting the child–bearing age, the comprehensive counseling, family planning and selection of appropriate treatment are recommended before pregnancy.Current standard managements for epilepsy are established in Guideline 2018. In the near feature, it will be updated by the evidences of efficacy and tolerability of new drugs, such as lacosamide and perampanel, provided after 2016.
