Pregnancy and epilepsy

Swartjes, J.M.; Geijn, H.P. van

doi:10.1016/s0301-2115(98)00027-x

Cited by 19 publications

(16 citation statements)

References 99 publications

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“…To conclude: (1) in the group of women with epilepsy there were more pregnancy complications; (2) cesarean section was performed more frequently in epileptics than in the controls; (3) an increased risk of congenital malformations and intrauterine fetal growth retardation was observed, and (4) women with epilepsy require appropriate pregnancy planning and appropriate neurologic and obstetric care preconceptionally and during pregnancy.…”

Section: Discussionmentioning

confidence: 97%

“…Maternal and neonatal outcome can be optimized by carefully evaluating the clinical necessity of anticonvulsant medication and by appropriate choice and determination of the optimum dose of anticonvulsant medication preconceptionally [1,8]. In addition, folic acid and vitamin K can help to optimize neonatal outcome [1]. Diet prior to conception and during organogenesis should contain adequate amounts of folate [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…It is the most frequent neurological disease in pregnancy and increases the risks for a variety of complications for the pregnant woman and her infant [1]. The absolute risk of major fetal malformations in women exposed to antiepileptic drugs is about 7-10%, approximately 3-5% higher than in the general population [2].…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy in Women with Epilepsy

Laskowska¹,

Leszczyńska‐Gorzelak²,

Oleszczuk³

2001

Gynecol Obstet Invest

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The aim of this study was to analyze the outcome of pregnancy and delivery in epileptic women. A retrospective review of the 41 pregnant women with epilepsy who delivered in the Department of Obstetrics and Perinatology of the University School of Medicine in Lublin over 7 years (1993–1999) was carried out. Women with epilepsy had more pregnancy complications including premature labor, anemia, hypertension, vaginal bleeding, urinary tract infection, nausea and vomiting. An increased risk of congenital malformations and intrauterine fetal growth retardation was observed. Women with epilepsy require more extensive pregnancy planning including neurologic and preconceptional care.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Pregnancy in Women with Epilepsy

Laskowska¹,

Leszczyńska‐Gorzelak²,

Oleszczuk³

2001

Gynecol Obstet Invest

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“…The factors underlying the changes in neuronal excitability during pregnancy have been proposed to result from stress, changes in sleep patterns, metabolic factors, respiratory changes, noncompliance with drugs, changes in the pharmacokinetics of drugs, and changes in seizure propensity during pregnancy (for review, see Swartjes and van Geijn, 1998). Although changes in seizure propensity have been proposed to occur during pregnancy, there is little evidence of intrinsic changes that would render the brain more susceptible to seizures.…”

Section: Discussionmentioning

confidence: 99%

Excitability Changes Related to GABA_AReceptor Plasticity during Pregnancy

Maguire¹,

Ferando²,

Simonsen³

et al. 2009

J. Neurosci.

120

127

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Alterations in GABA A receptor (GABA A R) expression and function, similar to those we described previously during pregnancy in the mouse dentate gyrus, may also occur in other brain regions. Here we show, using immunohistochemical techniques, a decreased ␦ subunit-containing GABA A R (␦GABA A R) expression in the dentate gyrus, hippocampal CA1 region, thalamus, and striatum but not in the cerebral cortex. In the face of the highly elevated neurosteroid levels during pregnancy, which can act on ␦GABA A Rs, it may be beneficial to decrease the number of neurosteroid-sensitive receptors to maintain a steady-state level of neuronal excitability throughout pregnancy. Consistent with this hypothesis, the synaptic input/output (I/O) relationship in the dentate gyrus molecular layer in response to lateral perforant path stimulation was shifted to the left in hippocampal slices from pregnant compared with virgin mice. The addition of allopregnanolone, at levels comparable with those found during pregnancy (100 nM), shifted the I/O curves in pregnant mice back to virgin levels. There was a decreased threshold to induce epileptiform local field potentials in slices from pregnant mice compared with virgin, but allopregnanolone reverted the threshold for inducing epileptiform activity to virgin levels. According to these data, neuronal excitability is increased in pregnant mice in the absence of allopregnanolone attributable to brain region-specific downregulation of ␦GABA A R expression. In brain regions, such as the cortex, that do not exhibit alterations in ␦GABA A R expression, there were no changes in the I/O relationship during pregnancy. Similarly, no changes in network excitability were detected in pregnant Gabrd Ϫ/Ϫ mice that lack ␦GABA A Rs, suggesting that changes in neuronal excitability during pregnancy are attributable to alterations in the expression of these receptors. Our findings indicate that alterations in ␦GABA A R expression during pregnancy result in brain region-specific increases in neuronal excitability that are restored by the high levels of allopregnanolone under normal conditions but under pathological conditions may result in neurological and psychiatric disorders associated with pregnancy and postpartum.

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“…Estudos recentes relatam que a freqüência das crises não é alterada signifi cativamente na gravidez na maior parte (60 a 83%) das mulheres com epilepsia 28 , mas que o efeito da gravidez sobre a epilepsia é imprevisível 28,29 . A gravidade da epilepsia anterior à gestação é indicativa da exacerbação das crises durante a mesma.…”

Section: Anticonvulsivantesunclassified

Transferência placentária de drogas

Cavalli¹,

Baraldi²,

Cunha³

2006

Rev. Bras. Ginecol. Obstet.

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ResumoGrávidas podem depender do uso de medicações para minimizar os agravos da doença preexistente. A gravidez, por si só, pode causar situações que comprometem o bem-estar materno, como náuseas e vômitos, as quais necessitam de tratamento. O obstetra deve estar atento à transferência placentária de drogas e à exposição do feto a agentes teratogênicos ou tóxicos, que podem comprometer o seu desenvolvimento ou mesmo sua vida futura.O transporte através da placenta envolve o movimento de moléculas entre três compartimentos: sangue materno, citoplasma do sinciciotrofoblasto e sangue fetal. Esse movimento pode ocorrer pelos seguintes mecanismos: difusão simples, difusão facilitada, transporte ativo, bombas classe P, V, F e grande família ABC e endocitose. Com o uso de anticonvulsivantes a incidência de malformações maiores em recém-nascidos expostos é de 4 a 6%, comparado com 2 a 4% na população geral. A politerapia é mais lesiva, especialmente se o ácido valpróico e a hidantoína fazem parte da associação. Para as pacientes epilépticas clinicamente assintomáticas há dois anos recomenda-se a suspensão da drogas em uso, porém se apresentam crises, torna-se prudente consultar neurologista para discussão da terapia anticonvulsivante com melhores benefícios e menores efeitos colaterais. Os anestésicos locais e os opióides são largamente utilizados durante a resolução da gestação. A lidocaína utilizada como anestésico por via perineal para episiotomia, na dose fi xa de 400 mg, apresenta alta concentração plasmática materna e alta taxa de transferência placentária no momento do nascimento, que vem alertar para o cuidado no uso de doses repetidas. A bupivacaína administrada por via epidural representa anestésico seguro, apresentando-se na forma racêmica e com transferência placentária em torno de 30%. A fentanila, anestésico opióide, utilizado por via epidural na resolução por cesariana, na dose fi xa de 0,10 mg, apresenta alta taxa de transferência placentária, da ordem de 90%, o que vem alertar para cautela no uso de doses repetidas em analgesia durante o trabalho de parto. PALAVRA-CHAVES:Troca materno-fetal; Anormalidades induzidas por drogas; Gravidez, Anticonvulsivos/efeitos adversos; Anestésicos/efeitos adversos Abstract Pregnant women may depend on the use of medications to minimize the problems caused by preexisting disease, and pregnancy itself can cause situations that compromise the maternal well-being and that require treatment. The obstetrician should be aware of the placental transfer of drugs and of fetal exposure to teratogenic or toxic agents that might compromise the development of the fetus or even its future life.Transport through the placenta involves the movement of molecules between three compartments: maternal blood, cytoplasm of the syncytiotrophoblast, and fetal blood. This movement can occur through the following mechanisms: simple diffusion, facilitated diffusion, active transport, class P, V, F and large ABC family pumps, and endocytosis. With the use of anticonvulsants the incidence of major m...

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Pregnancy and epilepsy

Cited by 19 publications

References 99 publications

Pregnancy in Women with Epilepsy

Pregnancy in Women with Epilepsy

Excitability Changes Related to GABA_AReceptor Plasticity during Pregnancy

Transferência placentária de drogas

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Pregnancy and epilepsy

Cited by 19 publications

References 99 publications

Pregnancy in Women with Epilepsy

Pregnancy in Women with Epilepsy

Excitability Changes Related to GABAAReceptor Plasticity during Pregnancy

Transferência placentária de drogas

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Excitability Changes Related to GABA_AReceptor Plasticity during Pregnancy