amakuru

Ku bagore bafite imyaka y’imyororokere bafite igicuri, umutekano w’imiti igabanya ubukana ni ingenzi kuri bo no ku rubyaro rwabo, kuko akenshi usanga imiti isabwa mu gihe cyo gutwita no konsa kugira ngo igabanye ingaruka zifata. Niba imikurire y'uruhinja iterwa no kuvura imiti igabanya ubukana bwa nyina mugihe utwite. Ubushakashatsi bwashize bwerekanye ko mu miti gakondo irwanya gufatwa, aside valproic, fenobarbital, na karbamazepine ishobora gutera ingaruka za teratogene. Mu miti mishya yo kurwanya igifu, lamotigine ifatwa nkaho ifite umutekano muke ku mwana, mugihe topiramate ishobora kongera ibyago byo kuvuka kwiminwa.

Ubushakashatsi bwinshi bwakozwe na neurodevelopmental bwerekanye isano iri hagati yo gukoresha umubyeyi ukoresha aside ya valproic mugihe cyo gutwita no kugabanuka kwimikorere yubwenge, autism, hamwe nubwitonzi bukabije bwa hyperactivite (ADHD) kubyara. Nyamara, ibimenyetso byujuje ubuziranenge ku isano iri hagati yo gukoresha topiramate y’ababyeyi igihe batwite ndetse n’iterambere ry’imyororokere y’urubyaro ntirihagije. Igishimishije, ubushakashatsi bushya bwasohotse mu cyumweru gishize mu kinyamakuru cyitwa New England Journal of Medicine (NEJM) kituzanira ibimenyetso byinshi

Mu isi isanzwe, ibigeragezo binini byateganijwe byateganijwe ntibishoboka ku bagore batwite bafite igicuri bakeneye imiti igabanya ubukana kugira ngo bakore iperereza ku mutekano w’ibiyobyabwenge. Nkigisubizo, kwiyandikisha gutwita, ubushakashatsi bwa cohort, hamwe nubushakashatsi-bwo kugenzura byabaye ibintu bisanzwe bikoreshwa mubushakashatsi. Duhereye ku buryo bw'uburyo, ubu bushakashatsi ni bumwe mu bushakashatsi bufite ireme bushobora gushyirwa mu bikorwa muri iki gihe. Ibikurubikuru byayo ni ibi bikurikira: uburyo bushingiye ku baturage-bunini bw'icyitegererezo cohort yo kwiga. Nubwo igishushanyo gisubira inyuma, amakuru aturuka mububiko bubiri bunini bwigihugu bwa sisitemu yo muri Amerika Medicaid na Medicare yanditswe mbere, bityo amakuru yizewe ni menshi; Igihe cyo gukurikirana hagati ya midiyani cyari imyaka 2, ahanini cyujuje igihe gikenewe cyo gusuzuma indwara ya autism, kandi hafi 10% (abantu barenga 400.000 bose hamwe) bakurikiranwe mumyaka irenga 8.

Ubushakashatsi bwarimo abagore barenga miliyoni 4 bujuje ibisabwa, 28,952 muri bo basuzumwe igicuri. Abagore bishyizwe hamwe bakurikije niba bafata imiti igabanya ubukana cyangwa imiti itandukanye igabanya ubukana nyuma yibyumweru 19 batwite (icyiciro iyo synaps ikomeje kubaho). Topiramate yari mu itsinda ryagaragaye, aside valproic yari mu itsinda rishinzwe kugenzura neza, na lamotigine yari mu itsinda rishinzwe kugenzura nabi. Itsinda rishinzwe kugenzura ridasobanutse ryarimo abagore bose batwite batigeze bafata imiti igabanya ubukana kuva iminsi 90 mbere yimihango yabo ya nyuma kugeza igihe cyo kubyara (harimo na epilepsi idakora cyangwa itavuwe).

Ibisubizo byerekanye ko umubare w’abantu bafite ikibazo cyo kwandura indwara ya autism ku myaka 8 ari 1.89% mu rubyaro rwose rutagaragaye ku miti iyo ari yo yose igabanya ubukana; Mu rubyaro rwavutse ku babyeyi b'igicuri, umubare rusange w'abantu bafite ikibazo cyo guta umutwe wari 4.21% (95% CI, 3.27-5.16) ku bana batigeze bahura n'imiti igabanya ubukana. Umubare w'indwara ya autism mu rubyaro rwerekanwe na topiramate, valproate, cyangwa lamotigine yari 6.15% (95% CI, 2.98-9.13), 10.51% (95% CI, 6.78-14.24), na 4.08% (95% CI, 2.75-5.41).

Ugereranije n'udusoro tutagaragaye ku miti igabanya ubukana, ibyago bya autism byahinduwe ku manota yerekana ko byari ibi bikurikira: Byari 0.96 (95% CI, 0.56 ~ 1.65) mu itsinda rya topiramate, 2.67 (95% CI, 1.69 ~ 4.20) mu itsinda ryerekana aside aside, na 1.00 (95% CI, 0.69 ~ 1.46) mu itsinda rya lamotrigine. Mu isesengura ry’itsinda, abanditsi bafashe imyanzuro isa n’uko abarwayi bahawe imiti ivura imiti, urugero rw’imiti ivura imiti, ndetse n’uko hari ibiyobyabwenge bifitanye isano no gutwita hakiri kare.

Ibisubizo byagaragaje ko urubyaro rw’abagore batwite barwaye igicuri rwagize ibyago byinshi byo kwandura indwara (4,21%). Yaba topiramate cyangwa lamotigine ntabwo byongereye ibyago byo guterwa mu rubyaro rw'ababyeyi bafashe imiti igabanya ubukana igihe batwite; Ariko, mugihe acide valproic yafashwe mugihe cyo gutwita, wasangaga ibyago biterwa na dose byongera ibyago byo guterwa no kubyara. Nubwo ubushakashatsi bwibanze gusa ku kwibasirwa na autism mu rubyaro rw’abagore batwite bafata imiti igabanya ubukana, kandi ntirwigeze rugaragaza izindi ngaruka zisanzwe ziterwa n’imyororokere nko kugabanuka kwubwenge mu rubyaro na ADHD, iracyagaragaza intege nke za neurotoxicity ya topiramate mu rubyaro ugereranije na valproate.

Topiramate mubusanzwe ntabwo ifatwa nkigisimbura cyiza cya sodium valproate mugihe utwite, kuko irashobora kongera ibyago byo kuvunika iminwa niminwa kandi ntoya kumyaka yo gutwita. Byongeye kandi, hari ubushakashatsi bwerekana ko topiramate ishobora kongera ibyago byindwara zifata ubwonko. Nyamara, ubushakashatsi bwa NEJM bwerekana ko niba harebwa gusa ingaruka ku iterambere ry’imyororokere y’urubyaro, ku bagore batwite bakeneye gukoresha valproate mu kurwanya igicuri, ni ngombwa kongera ibyago by’indwara zifata ubwonko mu rubyaro. Topiramate irashobora gukoreshwa nkubundi buryo bwo kuvura. Twabibutsa ko umubare w’abantu bo mu birwa bya Aziya n’abandi bo mu birwa bya pasifika mu gice cyose ari muto cyane, bingana na 1% gusa by’itsinda ryose, kandi hashobora kubaho itandukaniro rishingiye ku moko mu ngaruka mbi ziterwa n’ibiyobyabwenge birwanya gufata, bityo rero niba ibyavuye muri ubu bushakashatsi bishobora kugera ku baturage bo muri Aziya (harimo n’Abashinwa) bigomba kwemezwa n’ibyavuye mu bushakashatsi bwakozwe n’abanya Aziya mu gihe kiri imbere.