双相情感障碍和多发性硬化症患者怀孕期间使用锂。

PubMed ID
发表日期 2020年Aug月

原始出处 临床神经药理学
Clinical neuropharmacology
作者 Lorettu  Liliana  Carpita  Barbara  Nivoli  Alessandra  Milia  Paolo  De Iorio  Giovanni  Cremone  Ivan Mirko  DellʼOsso  Liliana 

文献标题 双相情感障碍和多发性硬化症患者怀孕期间使用锂。
Lithium Use During Pregnancy in a Patient With Bipolar Disorder and Multiple Sclerosis.

文献摘要

虽然锂被广泛用作治疗情绪障碍的一线药物,但其稳定情绪的作用仍未被完全了解。越来越多的数据强调,锂似乎显示出更广泛的性质,包括神经保护作用。β-磷酸化酶可能参与了阿尔茨海默病相关的β-磷酸化酶的治疗作用。初步数据也支持锂在多发性硬化症中潜在的治疗作用,多发性硬化症是一种自身免疫性疾病,与心境障碍并存。锂与发育中胎儿的致畸风险相关;然而,最近对其致畸风险的向下估计表明,至少在某些情况下,锂对双相情感障碍母亲及其后代的潜在治疗益处应予以考虑。一位43岁的妇女先前被诊断为双相情感障碍,在怀孕期间,她接受了锂和甲状腺激素的补充治疗。患者在怀孕期间和5年的随访评估中都保持了安乐死状态。除了情绪稳定外,她的多发性硬化症没有任何症状进展或复发,她的女儿继续发展正常情况下这个案例支持了在怀孕期间平衡锂的情绪稳定益处和已知的致畸风险的考虑。该案例也支持了在MS合并双相情感障碍的情况下探索可能的额外益处。


Although lithium is widely used as a first-line treatment for mood disorders, its mood-stabilizing effects remain not fully understood. A growing body of data are stressing that lithium seems to show broader properties, including neuroprotective effects. Lithium's ability to inhibit glycogen synthase kinase 3β, an enzyme that participates in the phosphorylation of τ, a microtubule-associated protein, stimulated interest in its possible therapeutic role in Alzheimer disease and other neurodegenerative disorders. Preliminary data also support exploration of lithium's potential therapeutic role in multiple sclerosis, an autoimmune disorder that is associated with co-occurring mood disorders. Lithium is associated with teratogenic risks to the developing fetus; however, recently revised downward estimates of its teratogenic risk of causing fetal cardiac malformation suggest that its potential therapeutic benefit to both mothers with bipolar disorder and their offspring should be considered in at least some cases. A 43-year-old woman previously diagnosed with bipolar disorder and MS was treated with lithium and thyroid hormone supplementation as her sole medications during her pregnancy. The patient remained euthymic throughout her pregnancy and over the course of her 5-year follow-up evaluations on this medication regimen. In addition to her stable mood, there has been no symptomatic progression or relapse of her MS, and her daughter continues to develop normally.The case supports consideration of balancing lithium's mood-stabilizing benefit with its known teratogenic risk during pregnancy. The case also supports exploration of possible additional benefit in the context of MS co-occurring with bipolar disorder.


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