Executive Summary: Management of epilepsy in pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy

Tomson, Torbjörn; Battino, Dina; Bromley, Rebecca; Kochen, Silvia; Meador, Kimford J.; Pennell, Page B.; Thomas, Sanjeev V

doi:10.1111/epi.16395

Cited by 102 publications

(222 citation statements)

References 116 publications

(196 reference statements)

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“…Other studies have reported that the risk of VPA is dose-related. Earlier studies indicated that differences in neurocognition cause problems at a dose of 800-1000 mg of valproate [5,27], differences at lower doses have also been found (< 400 mg) [30], with higher doses giving rise to more problems [5,7,27]. Our negative finding may be due to the small sample size of the VPA-exposed group.…”

Section: Discussioncontrasting

confidence: 42%

Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure

et al. 2020

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Objective To examine neurocognitive functioning of children exposed prenatally to carbamazepine, lamotrigine, levetiracetam or valproate monotherapy. Methods In a prospective observational study, children aged 6 or 7 years, identified from the European Registry of Antiepileptic Drugs and Pregnancy database in The Netherlands, were assessed using the Wechsler Intelligence Scale for Children and the developmental neuropsychological assessment. Maternal IQ was measured using Wechsler Adult Intelligence Scale. Assessors were blinded to drug exposures. Results One hundred and sixty-one children (one set of twins and 21 sibling pairs) of 139 mothers were included. As a group, children achieved average scores on neurocognitive outcomes. Children exposed to valproate (n = 22) performed lower on all six neurocognitive domains, especially language, than those exposed to carbamazepine (n = 32), lamotrigine (n = 82) or levetiracetam (n = 25). After controlling for maternal IQ and drug dose, the verbal IQ of valproate-exposed children was on average 9.1 points lower than those exposed to carbamazepine (95% confidence interval [CI] 1.3-17.0; p = 0.023), 10.3 lower than lamotrigine-exposed children (CI 3.4-17.3; p = 0.004) and 13.4 lower than levetiracetam-exposed children (CI 5.2-21.6; p = 0.002). No significant dose-effect was found. Virtually no significant differences were found between lamotrigine and levetiracetam or lamotrigine and carbamazepine exposed children. Conclusions Consistent with previous research, valproate-exposed children experienced more problems compared to three other common antiepileptic drugs, while children exposed to lamotrigine, carbamazepine or levetiracetam revealed little to no problems. This illustrates the need for systematic follow-up of prenatally exposed children, to support pre-pregnancy counseling and treatment decisions in women of reproductive age.

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Section: Discussioncontrasting

confidence: 42%

Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure

et al. 2020

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“…Specific issues pertain to women with epilepsy who might become or who are pregnant: Some AEDs are known to have teratogenic effects and so choice and optimization of drug treatment in advance of any potential pregnancy in women of childbearing age is particularly important (Tomson et al ., 2019). Non‐adherence rates are increased during pregnancy (likely due to concerns over teratogenicity as well as other factors such as vomiting) (Schmidt et al ., 1983).…”

Section: Pregnancy In Women With Epilepsymentioning

confidence: 99%

Testing blood and CSF in people with epilepsy: a practical guide

Sutton¹,

Barca²,

Komoltsev³

et al. 2020

Epileptic Disorders

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Laboratory investigations, whilst not essential to the diagnosis of seizures or of epilepsy, can be fundamental to determining the cause and guiding management. Over 50% of first seizures have an acute symptomatic cause, including a range of metabolic, toxic or infectious cause. The same triggers can precipitate status epilepticus, either de novo or as part of a deterioration in control in individuals with established epilepsy. Some, such as hypoglycaemia or severe hyponatraemia, can be fatal without prompt identification and treatment. Failure to identify seizures associated with recreational drug or alcohol misuse can lead to inappropriate AED treatment, as well as a missed opportunity for more appropriate intervention. In individuals with established epilepsy on treatment, some laboratory monitoring is desirable at least occasionally, in particular, in relation to bone health, as well as in situations where changes in AED clearance or metabolism are likely (extremes of age, pregnancy, comorbid disorders of renal or hepatic function). For any clinician managing people with epilepsy, awareness of the commoner derangements associated with individual AEDs is essential to guide practice. In this article, we review indications for tests on blood, urine and/or cerebrospinal fluid in patients presenting with new‐onset seizures and status epilepticus and in people with established epilepsy presenting acutely or as part of planned monitoring. Important, but rare, neurometabolic and genetic disorders associated with epilepsy are also mentioned.

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“…While the vast majority addressed folate supplementation, the specific recommendations varied considerably as to dose and timing. The latter is probably a reflection of the lack of conclusive data when it comes to optimal dose for folate supplementation for women treated with AEDs 7 …”

Section: Discussionmentioning

confidence: 99%

“…Our survey therefore clearly demonstrates that there is a need for the development of up‐to‐date, globally applicable recommendations for the management of epilepsy during pregnancy. While there are limitations in the present evidence base, which leave clinicians and their patients without adequate information, the ILAE Task Force on Women and Pregnancy has recently published expert opinion recommendations in anticipation of more evidence‐based guidelines in the future 7 . Further, this TF is working with the ILAE Wikipedia team to create a series of pages containing guidance on pregnancy in women with epilepsy and their care which will be monitored and updated as new data and developments become available.…”

Section: Discussionmentioning

confidence: 99%

Global Survey of Guidelines for the Management of Epilepsy in Pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy

et al. 2020

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The ILAE Task Force on Women and Pregnancy conducted a survey among ILAE Chapters of their use of guidelines or recommendations for the management of women with epilepsy during pregnancy. A web‐based questionnaire including 10 questions was sent to the 118 ILAE Chapters in December 2017 with repeated reminders until the end of February 2018. In total, 77 chapters (65%) responded, although not to all questions. Out of those responding, 68% reported having guidelines or recommendations, 34% of which were from 2014 or earlier. At least 20% of the guidelines did not include information on possible risk to cognitive development, information regarding specific risks with specific antiepileptic drugs, nor recommendations regarding selection of antiepileptic drugs. Among those responding to the question, 91% reported that recommendations were made regarding folate supplementation, but the recommended dose ranged from 0.4 mg/d to 4 mg/d or more; 34% did not include recommendations regarding drug level monitoring during pregnancy, and 19% did not include guidelines on breastfeeding. Our survey demonstrates that there is a need for the development of up‐to‐date, globally applicable recommendations for the management of epilepsy during pregnancy.

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Executive Summary: Management of epilepsy in pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy

Cited by 102 publications

References 116 publications

Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure

Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure

Testing blood and CSF in people with epilepsy: a practical guide

Global Survey of Guidelines for the Management of Epilepsy in Pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy

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