Epileptic disorders in pregnancy: an overview

Department ofNeurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Current opinion in obstetrics & gynecology (Impact Factor: 2.07). 01/2009; 20(6):557-62. DOI: 10.1097/GCO.0b013e3283184059
Source: PubMed


Much new information has now become available regarding outcomes of women with epilepsy (WWE) and pregnancy.
Valproate is associated with a risk of major congenital malformations within a range of 6.2-10.7%, though antiepileptic drugs (AEDs) other than valproate when used as monotherapy are associated with major congenital malformation rates ranging from 2.9 to 3.6%; the rate of major congenital malformations in WWE not treated with AEDs was similar to this at 3.1%. Seizure freedom in 9-12 months before pregnancy is associated with seizure freedom during pregnancy. A decline in AED levels can be expected during pregnancy, most dramatically for lamotrigine (but with marked variability between patients) and least with carbamazepine. Neonates born to WWE taking AEDs who receive vitamin K 1 mg intramuscularly at birth are not at additional risk of hemorrhagic disease of the newborn.
The use of valproate and polytherapy with any AED combinations should be avoided, if clinically appropriate, during pregnancy. Seizure freedom in 9-12 months before pregnancy should be a goal. AED levels should be maintained at or near the therapeutic level known for that individual patient, with frequent monitoring during pregnancy as appropriate for the patient and the AED.

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    • "Some previous studies showed that mothers’ neurological problems took place in about 0.3--0.6% of all pregnancies.[17–19] The outcome of pregnancy is good in majority of gestations, but some studies have reported that the rate of some complications such as hyperemesis gravidarum, preterm labor, pregnancy induced hypertension, preeclampsia, cesarean delivery, placental abruption, and perinatal mortality is higher in these women.[20–22] "
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    ABSTRACT: Epilepsy is a rare neurologic disorder during pregnancy. Despite its rarity, it could cause different clinical problems in this natural phenomenon of a woman's life. The aim of this study was to evaluate and compare the course of pregnancy and labor and their outcome in epileptic and healthy women. This study was performed during years 2009--2011 in Alzahra and Beheshti hospitals affiliated to Isfahan University of Medical Sciences. A total of 51 pregnant women, who were known cases of epilepsy and were on antiepileptic drugs treatment for at least 3 months, were compared with 47 matched healthy pregnant women without epilepsy. They were followed before and during their pregnancy in several visits and all of their neurologic and obstetric information were collected. For statistical analysis of continuous variables, the t-test was used. The chi-square test was used for dichotomous variables. The rate of monotherapy was more than polytheraphy especially during the pregnancy. The epileptic attacks stopped in majority of patients during the pregnancy. Vaginal bleeding (P=0.020) and abortion (P=0.015) were significantly more frequent among epileptic mothers. The gestational age was lower meaningfully (P= 0.010) in epileptic patients' neonates and the first minute Apgar score was lower in these babies too (P=0.028). Antiepileptic drugs could have some unsuitable effects on pregnancy course especially by increasing the rate of abortion, preterm labor, and vaginal bleeding. Their adverse effects on neonates' health could not be neglected.
    03/2012; 1:4. DOI:10.4103/2277-9175.94426
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    • "Prospective and retrospective studies demonstrate that VPA is a human teratogen, with an approximately threefold increase in major anomalies [131, 132], which is greater than that observed for other antiepileptic drugs (AEDs). Comparative studies show that while other AEDs increase the risk of malformation from 2.9 to 3.6%, the risk of major congenital malformation obtained with VPA is between 6.2 and 7.6% [143]. These disorders usually comprise spina bifida, and more rarely anencephaly, cardiac, craniofacial skeletal or limb defects, dysmorphic features, and a decrease in intrauterine growth (Valproate syndrome) [130]. "
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    ABSTRACT: Valproic acid (VPA), a branched short-chain fatty acid, is widely used as an antiepileptic drug and a mood stabilizer. Antiepileptic properties have been attributed to inhibition of Gamma Amino Butyrate (GABA) transaminobutyrate and of ion channels. VPA was recently classified among the Histone Deacetylase Inhibitors, acting directly at the level of gene transcription by inhibiting histone deacetylation and making transcription sites more accessible. VPA is a widely used drug, particularly for children suffering from epilepsy. Due to the increasing number of clinical trials involving VPA, and interesting results obtained, this molecule will be implicated in an increasing number of therapies. However side effects of VPA are substantially described in the literature whereas they are poorly discussed in articles focusing on its therapeutic use. This paper aims to give an overview of the different clinical-trials involving VPA and its side effects encountered during treatment as well as its molecular properties.
    BioMed Research International 07/2010; 2010(3). DOI:10.1155/2010/479364 · 2.71 Impact Factor
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    ABSTRACT: Critical care support and admission to an ICU is a relatively infrequent occurrence during pregnancy and the postpartum period Retrospective analyses of hospital admissions and complication rates indicate that 0.11–1.1% of deliveries are complicated by maternal ICU admission Patient demographics and hospital type clearly vary and affect outcomes differently; therefore, understanding the true risk of obstetric complications is somewhat difficult Literature suggests that these complications may account for most or only a portion of ICU admissions in pregnant patients (i.e., 19–93%); however, it is clear that maternal morbidity and mortality can be substantial when pregnant women require critical care In one study, 71% of obstetric patients transferred to the ICU required ventilatory support; other studies that indicate mortality ranges from 5 to 20% Treatment of critically ill pregnant women is challenged by limited information regarding safety profiles of therapeutic agents and the necessity to simultaneously manage mother and pregnancy viability Survival depends on care algorithms that allow for early detection of maternal problems and prompt referral to tertiary centers with ICUs Proactive and aggressive measures, including optimal cardiopulmonary management, minimize the incidence of multiorgan failure and mortality Admission criteria for appropriate triage are essential; decisions may be based on several models (which utilize prioritization) or diagnostic and objective parameters The American College of Critical Care Medicine summarized qualifications for ICU admission; this diagnostic model (Table 33.1) uses specific conditions or diseases to determine appropriateness of ICU admission General criteria for admission to an obstetric intermediate care unit are listed in Table 33.2
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