Epilepsy and pregnancy: What should the neurologists do?

Vercueil, L

doi:10.1016/j.neurol.2021.01.003

Cited by 11 publications

(11 citation statements)

References 99 publications

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“… 17 The intrauterine devices have emerged as the method of choices with the lowest failure rate for WWE. 18 …”

Section: Contraception Considerations For Wwementioning

confidence: 99%

“…17 The intrauterine devices have emerged as the method of choices with the lowest failure rate for WWE. 18 For women taking medications metabolized by hepatic cytochrome P450 enzymes, oral contraceptive failure can occur. Hepatic cytochrome P450 systems metabolize female sex steroids, thus impacting oral contraceptive effectiveness.…”

Section: Contraception Considerations For Wwementioning

confidence: 99%

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Issues of Women with Epilepsy and Suitable Antiseizure Drugs

Lee

2023

J Epilepsy Res

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Seizure aggravation in women with epilepsy (WWE) tends to occur at two specific times during the menstrual cycle: the perimenstrual phase and the ovulation period. Antiseizure drugs (ASDs), especially those that induce enzymes, can accelerate the metabolism of hormones in oral contraceptives, rendering them less effective. Estrogen in contraceptive pills increases the metabolism of lamotrigine. Physiological changes during pregnancy can significantly impact the pharmacokinetics of ASDs, potentially necessitating adjustments in dosage for women with epilepsy to maintain seizure control. The use of valproate in pregnant women is associated with the highest risk of major congenital malformations among ASDs. Risks of major congenital malformations associated with lamotrigine, levetiracetam, and oxcarbazepine were within the range reported in the general population. Exposure to valproate can lead to lower IQ in offspring. Reduced folic acid levels are linked to orofacial clefts, cardiovascular malformations, and urogenital and limb anomalies in WWE. Decreased folate levels are expected with the use of enzyme-inducing ASDs. However, a high dose of folate was associated with an increased risk of cancer in children of mothers with epilepsy. Most ASDs are generally considered safe for breastfeeding and should be encouraged. However, no single ASD is considered ideal for childbearing WWE. Lamotrigine and levetiracetam are relatively more suitable options for this situation.

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“… 17 The intrauterine devices have emerged as the method of choices with the lowest failure rate for WWE. 18 …”

Section: Contraception Considerations For Wwementioning

confidence: 99%

Section: Contraception Considerations For Wwementioning

confidence: 99%

Issues of Women with Epilepsy and Suitable Antiseizure Drugs

Lee

2023

J Epilepsy Res

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“…There are high chances of the second child acquiring abnormalities (about 17-36%) in conditions where the first child had abnormalities due to antiepileptic drug use [12]. Figure 1 summarizes some common anomalies that were observed in mice fetuses based on a histochemical study on prenatal valproic acid exposure [30].…”

Section: Sodium Valproate In Pregnancymentioning

confidence: 99%

Measures to Mitigate Sodium Valproate Use in Pregnant Women With Epilepsy

Ranjith¹,

Joshi²

2022

Cureus

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Sodium valproate is a sodium salt of valproic acid. It is often used in the medical treatment of several conditions like epilepsy, bipolar disorder, mania, and migraines. This review debates whether the usage of valproic acid is appropriate in pregnancy. It also lists the various neonatal deformities and other teratogenic effects the said drug presents due to prenatal exposure to the drug and the implications of continuing drug therapy in certain situations. We should often weigh the outcomes and implement it only in conditions where its use is inevitable. It also includes the importance of awareness among middle-aged women with mental illness regarding the teratogenic effects of sodium valproate use and the relevance of discussion by physicians with patients regarding the usage of this drug despite being aware of the complications. It also explores other treatment options and modalities that can be used in the place of valproic acid for epilepsy and bipolar disorder in pregnant women and women of the reproductive age group, and how we can mitigate the usage of this drug by implementing various measures by referring to various guidelines present in different areas of the world. In summary, this article explores the numerous teratogenic effects sodium valproate presents in pregnancy, alternative medications, and treatment options instead of valproate. It also enumerates conditions where valproate use is necessary and how we can reduce and prevent the usage of valproate in pregnancy by opting for pregnancy prevention programs during valproate use and various other guidelines.

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“…Destaca-se, entre elas, a mudança do balanço eletrolítico e variações dos hormônios durante a gestação, contribuindo para retenção de líquido e alteração na concentração e metabolização das DAEs. 2,3 Além disso, é reconhecida a possibilidade de recusa das gestantes de seguir com o tratamento medicamentoso, a fim de preservar o feto de uma possível complicação causada pelos medicamentos.…”

Section: Introductionunclassified

Terapia de estimulação do nervo vago em mulheres grávidas com epilepsia: uma revisão de literatura

Leitão,

De Sales Filho,

Fernandes

et al. 2023

Braz. J. Hea. Rev.

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Mulheres epilépticas grávidas apresentam desafios únicos para o controle farmacológico das crises convulsivas, dada à teratogenicidade de muitos desses fármacos e ao aumento do número de crises no período gestacional. Nesse cenário, terapias não farmacológicas como a estimulação do nervo vago ganham bastante destaque. A terapia consiste no implante de eletrodos no nervo vago esquerdo, gerando impulsos que modificam a atividade elétrica estereotipada de uma convulsão e com isso reduz até 50% dos episódios de crises no primeiro ano de uso. Esta revisão integrativa objetiva avaliar os resultados da estimulação vagal em grávidas epilépticas. Foram utilizados os Medical Subject Headings (MeSH) “Drug Resistant Epilepsy”, "Vagus Nerve Stimulation" e "Pregnancy" nas bases de dados PubMed e Biblioteca Virtual em Saúde incluindo os trabalhos publicados nos últimos 10 anos. Das 25 publicações encontradas, apenas 12 atenderam aos critérios de inclusão do estudo, com outros 7 trabalhos sendo incluídos a partir da busca nas referências dos estudos selecionados inicialmente, totalizando 19 artigos para a análise. Os achados demonstraram que embora haja um aumento de intervenções obstétricas em mulheres que aderem ao tratamento, não se pode afirmar que são devido à estimulação vagal e elas não pareceram refletir em riscos à saúde materno-fetal. Além disso, pacientes que associavam o estímulo vagal com polifarmácia tiveram mais intervenções obstétricas do que pacientes que a associavam com a monoterapia farmacológica. Sendo assim, acredita-se que a terapia de estimulação de nervo vago seja benéfica para as gestantes, visto que pode reduzir a quantidade de drogas utilizadas no controle das crises, diminuindo a carga teratogênica da terapia, embora mais estudos multicêntricos sejam necessários para afirmar com maior evidência a segurança da estimulação vagal.

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Epilepsy and pregnancy: What should the neurologists do?

Cited by 11 publications

References 99 publications

Issues of Women with Epilepsy and Suitable Antiseizure Drugs

Issues of Women with Epilepsy and Suitable Antiseizure Drugs

Measures to Mitigate Sodium Valproate Use in Pregnant Women With Epilepsy

Terapia de estimulação do nervo vago em mulheres grávidas com epilepsia: uma revisão de literatura

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