Common antiepileptic drugs in pregnancy in women with epilepsy

Smith, Catrin Tudur; Vinten, Jacqui; Williamson, Paula; Winterbottom, Janine B; McKay, A. J.; Bromley, Rebecca

doi:10.1002/14651858.cd004848.pub2

Cited by 12 publications

(12 citation statements)

References 52 publications

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“…Bununla birlikte, epilepsi hastası olan gebelerin yaklaşık yarısının bu dönemde nöbet geçirmedikleri görülebilmektedir. [10,11] Melikova ve ark.nın [12] [13][14][15][16] Folik asit fetusun santral sinir sisteminin gelişiminde gereklidir, özellikle hızlı hücre bölünmesi gebeliğin ilk trimesterinde önemlidir. Folik asit eksikliği olan gebelerin bebeklerinde, düşük doğum ağırlığı, prematür doğum, nöral tüp defekti gibi sorunların görülme sıklığı artmaktadır.…”

Section: Discussionunclassified

Prevalence of Seizures in Pregnant Women with Epilepsy and Pregnancy Outcomes

Pak¹,

Bozdemir²,

Aslan³

et al. 2018

Epilepsi

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Objectives: Management of pregnant patients with epilepsy is difficult. Despite the high healthy birth rate (92-96%); prematurity, fetal or neonatal death, congenital malformations and developmental failure rates are higher than the average population. The seizure rates of the majority of the patients with epilepsy do not change during pregnancy. The purpose of this study is to determine the frequency of epileptic seizures of the patients during pregnancy and rate of malformations that may be encountered in newborn babies.Methods: 55 pregnant patients with epilepsy who were born between February 2014 and February 2016 were included in the study. Types of seizures, frequency, anti-epileptic drugs used, measures of infants, malformations in infants were recorded. Results: During pregnancy; it was determined that the frequency of seizure was 56.4% (n=31), and 21.8% of patients (n=12) had increased seizure frequency whereas 21.8% (n=12) had lower seizure frequency. 3.6% of infants were lost in intrauterine. 7.3% of infants had a malformation.Conclusion: Only 21.8% of the pregnant women had an increase in seizure frequency. Malformation and mortality rates were higher in infants of patients with generalised seizures. It was observed that patients who used monotherapy gave birth to more healthy babies than those using polytherapy.Amaç: Epilepsi tanılı gebe hastaların yönetimi zordur. Yüksek oranda sağlıklı (%92-96) çocuk doğurmalarına rağmen, prematüre doğum, fetal ve neonatal ölüm riski, konjenital malformasyonlar ve gelişme geriliği oranları normal populasyona göre artış göstermektedir. Epilepsi tanılı kadın hastaların büyük kısmında gebelik döneminde nöbet sıklıkları değişmemektedir. Bu çalışmada amaç epilepsi tanılı gebelerin, gebelik dönemindeki nöbet sıklıkları ve bu nöbetlerin yenidoğan bebeğin gelişim parametrelerine etkisinin ve yenidoğan bebekte karşılaşılabilecek malformasyonların belirlenmesidir. Gereç ve Yöntem:On dört Şubat 2014-14 Şubat 2016 tarihleri arasında doğumu gerçekleşen 55 epilepsi tanılı gebe hasta çalışmaya alındı. Nöbet tipi, sıklıkları, kullandıkları anti epileptik ilaçlar, bebeklerin ölçüleri, bebeklerdeki malformasyonlar kaydedildi. Bulgular: Gebelik süresince; hastaların %56,4 (n=31)'ünün nöbet sıklığının değişmediği, %21.8'inin (n=12) nöbet sıklığının arttığı, %21.8'inin (n=12) nöbet sıklığının azaldığı belirlendi. Bebeklerden %3.6'sı intrauterin eksitus oldu. Bebeklerin %7.3'ünde malformasyon saptandı.Sonuç: Gebelerin sadece %21.8'inde nöbet sıklığının arttığı saptanmıştır. Jeneralize nöbeti olan hastaların bebeklerinde malformasyon ve mortalite oranı daha yüksek bulundu. Monoterapi kullanan hastaların, politerapi kullananlara göre daha yüksek oranda sağlıklı bebek doğurdukları gözlendi.

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Section: Discussionunclassified

Prevalence of Seizures in Pregnant Women with Epilepsy and Pregnancy Outcomes

Pak¹,

Bozdemir²,

Aslan³

et al. 2018

Epilepsi

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“…6 A Cochrane review of 22 observational prospective cohort studies and six register studies confirmed the observation of poorer neurodevelopmental outcomes of pregnancies exposed to valproate. 7 The effect is dose related and exacerbated by polytherapy. In 2015, the European Registry of Antiepileptic Drugs and Pregnancy (EURAP) study group (an International registry of antiepileptic drugs and pregnancy) published on 1,224 pregnancies where valproate was taken alone and a further 364 where it was taken alongside another epilepsy drug.…”

Section: The Evidencementioning

confidence: 99%

Valproate: life-saving, life-changing

Thomas

2018

Clinical Medicine

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s1-s8 LINACRE LECTURE both the widespread harm caused to an estimated 10,000 children worldwide and the battle to recognise this risk and restrict its use. The drug had (and still has) many important medical uses, but when taken in early pregnancy to combat hyperemesis, affected children were born with significant limb deficits. Although withdrawn in the UK in 1961, it took a long campaign and press support before there was a compensation settlement. Therefore, when The Daily Telegraph headline on 30 July 2009 stated that valproate was responsible for 'worst child poisoning case since thalidomide' the connotation was stark and emotional (Fig 1 ). I will discuss the many reasons why the thalidomide comparison is understandable, but also why the circumstances are significantly different. This will be with the specific aim of promoting the unanimous advice about valproate in pregnancy from many august agencies, while also recognising that there are important evidence gaps. Valproate exposure in uteroValproate is a recognised teratogen and the major cause of fetal anticonvulsant syndrome. An estimated 10.7% of children exposed to valproate in utero are born with a major congenital malformation (that is, a structural abnormality that is recognisable at birth) in comparison to an estimated 2% of unexposed infants. 1This produces the first two problems: 1 doctors are often poor at explaining risk 2 patients are inexperienced in balancing these risks. This is exacerbated when the research evidence produces population risks ( ' a certain percent of affected children') whereas what we need is individualised risk ('your chance of having an affected baby is'). Equally, our prior experiences as physician and parent will sway the way we deal with perceived risk. The second issue is this: the fact that the concern regarding major malformations and valproate is so well known it has blinded us to the new scandal, the new relationship. We, as adult physicians have had 'change blindness' -we have failed to see that the threat of valproate is no longer limited to malformations at birth, but more far-reaching and life-changing developmental issues.The easiest associations to recognise are when infrequent exposures (unusual drug x) causes a dramatic, instant and frequently occurring outcome. A much more challenging situation is when a drug that has been available since the late 1960s, such as valproate, produces a delayed and variable effect, such as poorer cognition. Recognition is even harder when the effect is in the patients' offspring. This in part explains why the epilepsy community was so slow to recognise the extent of the risks.Antiepileptic medications, and valproate principally, are commonly prescribed teratogens. There is significant concern that we are not doing enough to educate clinicians and potential parents about the risks of valproate in pregnancy. There is clear advice from the Medicines and Healthcare products Regulatory Agency and the International League Against Epilepsy about the risks of valproate exposure in...

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“…Bu bulgular literatür ile uyumlu olup, konvülsif nöbetlerin teratojenik etkisinin daha fazla olduğunu düşündürmektedir. [10][11][12][13] Daha önceki çalışmalarda, epilepsi tanılı kadın-ların üçte birinde, gebelik sırasında nöbet sıklığında artma olduğu rapor edilmiştir.…”

Section: Nöbet Tipiunclassified

Maternal and Obstetric Outcome of Women with Epilepsy

Pak¹,

Bozdemir²,

Aslan³

et al. 2017

Turkiye Klinikleri J Neur

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Ö ÖZ ZE ET T A Am ma aç ç: : Epilepsili gebelerin ilaç yönetimi zordur. Yüksek oranda sağlıklı (%92-96) çocuk doğurmalarına rağmen, epilepsili hastalada; prematüre doğum, düşük doğum ağırlığı, fetal ve neonatal ölüm riski, konjenital malformasyonlar ve gelişme geriliği oranları normal populasyona göre artış göstermektedir. Bu çalışmada amaç epilepsili gebelerin, gebelik sonuçları, karşılaşılan doğum sorunları, yenidoğan bebeğin gelişim parametreleri ve karşılaşılabilecek malformasyonların belirlenmesidir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : On dört Şubat 2014-14 Şubat 2016 tarihleri arasında doğumu gerçekleşen 55 epilepsi tanılı gebe hasta çalışmaya alındı. Nöbet tipi, sıklıkları, kullandıkları antiepileptik ilaçlar, bebeklerin ölçüleri, bebeklerdeki malformasyonlar kaydedildi. B Bu ul lg gu ul la ar r: : Bebeklerden %3,6'sı intrauterin eksitus oldu. Bebek doğum ağırlığının ortalaması 3.088 g, bebeklerin %20'sinin doğum ağırlığı 2.500 g'ın altında olup, düşük doğum ağırlığına sahiplerdi. Bebek kafa ölçümü 33,98 cm, bebek boy ortalaması 48,44 cm şdi. Bebeklerin %7,3'ünde malformasyon (Fallot tetralojisi, sekundum atriyal septal defekt, gastroşizis, tiroid hipoplazisi, yarık damak veya yarık dudak) saptandı. S So on nu uç ç: : Jeneralize nöbeti olan hastaların bebeklerinde malformasyon ve mortalite oranı daha yüksek bulundu. Monoterapi kullanan hastaların, ilaçsız hastalara ve politerapi kullananlara göre daha yüksek oranda sağlıklı bebek doğurdukları gözlendi. Politerapi kullanan hastaların arasında da valproik asit kombinasyonu olan ve valproik asit dozu 1.000 mg/gün üstünde olan hastaların malformasyonlu bebek doğurma oranlarının daha yüksek olduğu saptandı.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Gebe kadınlar; epilepsiler, parsiyel; epilepsi, genel; antikonvülzanlar A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The drug management of epileptic pregnants is difficult. Despite the high birth rate of healthy (92-96%) children, premature birth, low birth weight, risk of fetal and neonatal mortality, congenital malfarmations and growth retardation rates of patients with epilepsy incrase compairt with normal population. In the study, the aim is to determine the pregnancy outcomes, the birth complications encountered, the development parameters of newborn baby and the determination of the malformations that may be encountered of epilectic pregnants. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 55 epileptic pregnant patients who gave birth between February 14 th 2014-February 14 th 2016 were enrolled to study seuizure type, frequency, anti epileptic drugs that were used, infants measurements, malformations in infants were recorded. R Re es su ul lt ts s: : 3.6% of infants were and intrauterine ecsitus. The average weight of baby birth was 3.088 g, 20% of infants were under 2.500 g and birth weight had low birth weight. Baby head measurement was 33.98 cm, the height average was 48.44 cm. In 7.3% of infants, malformations (Tetralogy of Falbt, securdum atrial s...

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Common antiepileptic drugs in pregnancy in women with epilepsy

Abstract: The editorial group responsible for this previously published document have withdrawn it from publication.

Cited by 12 publications

References 52 publications

Prevalence of Seizures in Pregnant Women with Epilepsy and Pregnancy Outcomes

Prevalence of Seizures in Pregnant Women with Epilepsy and Pregnancy Outcomes

Valproate: life-saving, life-changing

Maternal and Obstetric Outcome of Women with Epilepsy

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