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Antiepileptics in pregnancy

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https://www.readbyqxmd.com/read/27860117/development-of-a-core-outcome-set-for-epilepsy-in-pregnancy-e-core-a-national-multi-stakeholder-modified-delphi-consensus-study
#1
B H Al Wattar, K Tamilselvan, R Khan, A Kelso, A Sinha, A M Pirie, D McCorry, K S Khan, S Thangaratinam
OBJECTIVE: To develop a set of core outcomes for studies on pregnant women with epilepsy. DESIGN: Delphi consensus study. POPULATION: Healthcare professionals, and patient representatives with lived experience of epilepsy in the UK. METHODS: We used a modified Delphi method and a consultation meeting to achieve consensus. Potential outcomes were identified by systematic review, and were scored using a Likert scale anchored between 1 (least important) and 5 (most important)...
November 16, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/27829186/counseling-by-epileptologists-affects-contraceptive-choices-of-women-with-epilepsy
#2
Alyssa R Espinera, Jay Gavvala, Irena Bellinski, Jeffrey Kennedy, Micheal P Macken, Aditi Narechania, Jessica Templer, Stephen VanHaerents, Stephan U Schuele, Elizabeth E Gerard
INTRODUCTION: There are several important interactions between antiepileptic drugs (AEDs) and hormonal contraception that need to be carefully considered by women with epilepsy (WWE) and their practitioners. Many AEDs induce hepatic enzymes and decrease the efficacy of hormonal contraception. In addition, estrogen-containing hormonal contraception can increase the metabolism of lamotrigine, the most commonly prescribed AED in women of childbearing age. The intrauterine device (IUD) is a highly effective form of reversible contraception without AED drug interactions that is considered by many to be the contraceptive of choice for WWE...
October 29, 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/27819746/monotherapy-treatment-of-epilepsy-in-pregnancy-congenital-malformation-outcomes-in-the-child
#3
REVIEW
Jennifer Weston, Rebecca Bromley, Cerian F Jackson, Naghme Adab, Jill Clayton-Smith, Janette Greenhalgh, Juliet Hounsome, Andrew J McKay, Catrin Tudur Smith, Anthony G Marson
BACKGROUND: There is evidence that certain antiepileptic drugs (AEDs) are teratogenic and are associated with an increased risk of congenital malformation. The majority of women with epilepsy continue taking AEDs throughout pregnancy; therefore it is important that comprehensive information on the potential risks associated with AED treatment is available. OBJECTIVES: To assess the effects of prenatal exposure to AEDs on the prevalence of congenital malformations in the child...
November 7, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27813062/poor-versus-rich-children-with-epilepsy-have-the-same-clinical-course-and-remission-rates-but-a-less-favorable-social-outcome-a-population-based-study-with-25%C3%A2-years-of-follow-up
#4
Carol Camfield, Peter Camfield, Bruce Smith
OBJECTIVE: To explore the influence of several estimates of family socioeconomic status on the long-term clinical course and social outcomes of children with epilepsy. METHODS: The Nova Scotia childhood epilepsy cohort is population based and includes all children in this Canadian province who developed epilepsy between 1977 and 1985. Eligible patients had ≥10 years of follow-up. Children with childhood absence epilepsy were excluded. Total family income at seizure onset was assessed at seizure onset and classified as "poor" (first quintile), "adequate" (second to third quintiles), and "well-off" (fourth to fifth quintiles)...
November 2016: Epilepsia
https://www.readbyqxmd.com/read/27807736/-analgesic-drugs-during-pregnancy
#5
S Hultzsch, C Schaefer
Some important limitations must be taken into consideration for analgesic therapy during pregnancy. Paracetamol is the agent of choice for mild to moderate pain in any stage of pregnancy. Ibuprofen is the non-steroidal anti-inflammatory drug (NSAID) of choice; however, these substances are contraindicated after 28 weeks of gestation due to the increasing risk of premature closure of the ductus arteriosus and impairment of fetal kidney function. Even opioids can be used for severe pain but peripartum administration can lead to neonatal respiratory depression and adaptation disorders and long-term therapy up to the end of pregnancy can lead to neonatal withdrawal symptoms...
November 2, 2016: Der Schmerz
https://www.readbyqxmd.com/read/27802281/pregnancy-associated-changes-in-pharmacokinetics-a-systematic-review
#6
Gali Pariente, Tom Leibson, Alexandra Carls, Thomasin Adams-Webber, Shinya Ito, Gideon Koren
BACKGROUND: Women are commonly prescribed a variety of medications during pregnancy. As most organ systems are affected by the substantial anatomical and physiological changes that occur during pregnancy, it is expected that pharmacokinetics (PK) (absorption, distribution, metabolism, and excretion of drugs) would also be affected in ways that may necessitate changes in dosing schedules. The objective of this study was to systematically identify existing clinically relevant evidence on PK changes during pregnancy...
November 2016: PLoS Medicine
https://www.readbyqxmd.com/read/27778312/medication-adherence-in-women-with-epilepsy-who-are-planning-pregnancy
#7
Lia de Leon Ernst, Cynthia L Harden, Page B Pennell, Nichelle Llewellyn, Connie Lau, Sarah Barnard, Eyal Bartfeld, Jacqueline A French
OBJECTIVE: This study examines medication adherence among women with epilepsy via use of an electronic diary, as part of a prospective multicenter observational study designed to evaluate fertility in women with epilepsy (WWE) versus age-matched controls. METHODS: WWE and healthy age-matched controls, seeking pregnancy, were given an iPod Touch using a customized mobile application (the WEPOD App) for daily data tracking. Eighty-six WWE tracked seizures and antiepileptic drugs (AEDs)...
October 25, 2016: Epilepsia
https://www.readbyqxmd.com/read/27766590/an-updated-overview-on-therapeutic-drug-monitoring-of-recent-antiepileptic-drugs
#8
REVIEW
Shery Jacob, Anroop B Nair
Given the distinctive characteristics of both epilepsy and antiepileptic drugs (AEDs), therapeutic drug monitoring (TDM) can make a significant contribution to the field of epilepsy. The measurement and interpretation of serum drug concentrations can be of benefit in the treatment of uncontrollable seizures and in cases of clinical toxicity; it can aid in the individualization of therapy and in adjusting for variable or nonlinear pharmacokinetics; and can be useful in special populations such as pregnancy. This review examines the potential for TDM of newer AEDs such as eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, perampanel, pregabalin, rufinamide, retigabine, stiripentol, tiagabine, topiramate, vigabatrin, and zonisamide...
December 2016: Drugs in R&D
https://www.readbyqxmd.com/read/27735055/overweight-in-epilepsy-as-a-risk-factor-for-pregnancy-and-delivery-complications
#9
Eivind Kolstad, Gyri Veiby, Nils Erik Gilhus, Marte Bjørk
OBJECTIVE: To investigate whether prepregnancy overweight in women with epilepsy increases their risk for complications during pregnancy and delivery. METHODS: This study is based on The Norwegian Mother and Child Cohort Study (MoBa) linked to the Medical Birth Registry of Norway. A diagnosis of epilepsy was reported in 706 pregnancies. Overweight was defined as body mass index ≥ 25 prepregnancy. Overweight women with epilepsy (n = 259) were compared to normal-weight women with epilepsy (n = 416), and to women without epilepsy with and without overweight (n = 30,516 and n = 67,977, respectively)...
November 2016: Epilepsia
https://www.readbyqxmd.com/read/27732918/evidence-for-spared-attention-to-faces-in-7-month-old-infants-after-prenatal-exposure-to-antiepileptic-drugs
#10
Mari Videman, Susanna Stjerna, Reina Roivainen, Taina Nybo, Sampsa Vanhatalo, Eija Gaily, Jukka M Leppänen
INTRODUCTION: Prenatal antiepileptic drug (AED) exposure is associated with an increased risk of cognitive impairment and autism spectrum disorders detected mainly at the age of two to six years. We examined whether the developmental aberrations associated with prenatal AED exposure could be detected already in infancy and whether effects on visual attention can be observed at this early age. MATERIAL AND METHODS: We compared a prospective cohort of infants with in utero exposure to AED (n=56) with infants without drug exposures (n=62)...
October 9, 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/27703396/epilepsy-during-pregnancy-focus-on-management-strategies
#11
Laura M Borgelt, Felecia M Hart, Jacquelyn L Bainbridge
In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications...
2016: International Journal of Women's Health
https://www.readbyqxmd.com/read/27698740/neurological-teratogenic-effects-of-antiepileptic-drugs-during-pregnancy
#12
Qingmei Nie, Baohua Su, Jianping Wei
Epilepsy is one of the few neurologic disorders that requires a constant treatment during pregnancy. Epilepsy affects 0.3-0.8% of pregnant women. Prescription of antiepileptic drugs (AEDs) to pregnant women with epilepsy requires monitoring and maintaining a balance between limiting seizures and decreasing fetal exposure to the potential teratogenic effects. AEDs are also commonly used for psychiatric disorders, pain disorders, and migraines. The types of malformations that can result in fetuses exposed to AEDs include minor anomalies, major congenital malformations, intrauterine growth retardation, cognitive dysfunction, low IQ, microcephaly, and infant mortality...
October 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27678205/women-with-epilepsy-clinically-relevant-issues
#13
S Bangar, Abhishek Shastri, Hany El-Sayeh, Andrea E Cavanna
Women with epilepsy (WWE) face specific challenges throughout their lifespan due to the effects of seizures and antiepileptic drugs on hormonal function, potentially affecting both sexual and reproductive health. This review article addresses the most common issues of practical relevance to clinicians treating WWE: epidemiology and clinical presentations (including catamenial epilepsy), contraception, reproductive and sexual dysfunction, pregnancy, lactation, menopause-related issues (including bone health), and mental health aspects...
July 2016: Functional Neurology
https://www.readbyqxmd.com/read/27677612/women-with-epilepsy-initiating-a-progestin-iud-a-prospective-pilot-study-of-safety-and-acceptability
#14
Anne R Davis, Heva J Saadatmand, Alison Pack
OBJECTIVE: Effective contraception enables women with epilepsy (WWE) to plan their pregnancies and improve outcomes for themselves and their children. Although popular among all women, complex drug interactions limit the efficacy and safety of oral contraceptives (OCs) for WWE. We sought to explore the safety, acceptability, and pharmacokinetic impact of a progestin-containing intrauterine device (IUD) in WWE. METHODS: We enrolled 20 women with well-controlled epilepsy and a stable antiepileptic drug (AED) regimen and who were initiating a progestin-containing IUD (levonorgestrel 52 mg) in a prospective, observational study...
November 2016: Epilepsia
https://www.readbyqxmd.com/read/27631817/-pharmacological-treatment-of-women-with-epilepsy-before-and-during-pregnancy
#15
B Müffelmann, C G Bien
In the vast majority of women with epilepsy, no complications occur during pregnancy. Important for that is early, preconceptional counseling and close surveillance during pregnancy. The aim should be to maintain the best possible seizure control without occurrence of generalized tonic-clonic seizures while using antiepileptic drugs and with the lowest possible risk of malformations. The warnings for the prescription of valproic acid in women of reproductive age were tightened because of the dose-dependent increase in the malformation rate and other risks, especially regarding adverse effects on childhood cognitive development...
October 2016: Der Nervenarzt
https://www.readbyqxmd.com/read/27581218/cognition-in-school-age-children-exposed-to-levetiracetam-topiramate-or-sodium-valproate
#16
Rebecca L Bromley, Rebecca Calderbank, Christopher P Cheyne, Claire Rooney, Penny Trayner, Jill Clayton-Smith, Marta García-Fiñana, Beth Irwin, James Irvine Morrow, Rebekah Shallcross, Gus A Baker
OBJECTIVE: To investigate the effects of prenatal exposure to monotherapy levetiracetam, topiramate, and valproate on child cognitive functioning. METHODS: This was a cross-sectional observational study. Children exposed to monotherapy levetiracetam (n = 42), topiramate (n = 27), or valproate (n = 47) and a group of children born to women who had untreated epilepsy (n = 55) were enrolled retrospectively from the UK Epilepsy and Pregnancy Register. Assessor-blinded neuropsychological assessments were conducted between 5 and 9 years of age...
November 1, 2016: Neurology
https://www.readbyqxmd.com/read/27573510/antiepileptic-drugs-foetal-malformations-and-spontaneous-abortions
#17
F J E Vajda, T J O'Brien, J E Graham, A A Hitchcock, C M Lander, M J Eadie
BACKGROUND: Some recent studies have found an association between foetal malformations in earlier antiepileptic drug (AED)-exposed pregnancies and an increased hazard of such malformations in subsequent pregnancies. We investigated this matter further, and also considered the possible role of spontaneous abortions in previous pregnancies, in this situation. METHODS: Analysis of foetal malformation data for current and previous pregnancies in women taking AEDs and women with untreated epilepsy in the Australian Register of Antiepileptic Drugs in Pregnancy (APR) from 1999 to late 2014...
August 29, 2016: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/27570381/epileptiform-activity-in-the-electroencephalogram-of-6-year-old-children-of-women-with-epilepsy
#18
Unnikrishnan Krishnan Syam, Sanjeev V Thomas
PURPOSE: To study the epileptiform discharges (EDs) in the electroencephalogram (EEG) of 6-8-year-old children of women with epilepsy (WWE). MATERIALS AND METHODS: All children born to women with epilepsy and prospectively followed up through the Kerala Registry of Epilepsy and Pregnancy (KREP), aged 6-8 years, were invited (n = 532). Out of the 254 children who responded, clinical evaluations and a 30-min digital 18 channel EEG were completed in 185 children. RESULTS: Of the 185 children examined, 37 (20%) children (19 males, 18 females) had ED in their EEG...
July 2016: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27565413/anti-mullerian-hormone-is-higher-in-seizure-free-women-with-epilepsy-compared-to-those-with-ongoing-seizures
#19
Cynthia L Harden, Page B Pennell, Jacqueline A French, Anne Davis, Connie Lau, Nichelle Llewellyn, Benjamin Kaufman, Emilia Bagiella, Ariel Kirshenbaum
OBJECTIVE: To determine if anti-mullerian hormone (AMH), a neuroactive peptide hormone and a measure of ovarian reserve, is different between women with epilepsy (WWE) and healthy controls (HC) seeking pregnancy and to evaluate epilepsy-related factors associated with AMH concentrations. METHODS: Subjects were participants in Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD), a multi-center prospective, observational cohort study evaluating fecundity in WWE compared to HC, ages 18-40 years...
August 17, 2016: Epilepsy Research
https://www.readbyqxmd.com/read/27509652/-hypertensive-disorders-in-pregnant-woman-with-epilepsy
#20
Pl Bozhinov, S Bojinova
PURPOSE: To determine the frequency and the course of hypertensive disorders in pregnant women with epilepsy (PWWE). MATERIALS AND METHODS: The survey is prospective and covers 206 PWWE during the period 1997-2012 year, monitored and treated in Risk Pregnancy Clinic of University Hospital - Pleven. All the patients (PWWE) are with clinically established etiology and prescription of epilepsy, type of seizures and their frequency. EEG records, ultrasound of fetus and cardiotocograph monitoring were conducted...
2016: Akusherstvo i Ginekologii︠a︡
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