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Antiepileptics in pregnancy

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https://www.readbyqxmd.com/read/29141532/seizures-and-antiepileptic-drugs-from-pathophysiology-to-clinical-practice
#1
Nihan CarCaka, Cigdem Ozkara
Recurrent, spontaneous seizure activity caused by abnormal neuronal firing in the brain is a hallmark of epilepsy, a common chronic neurological disorder. Recent research that has expanded the knowledge of the cellular and molecular mechanisms that modulate neuronal excitability and network activity in the brain provides the development and discovery of antiepileptic drugs (AEDs). AED therapy starts with the selection of the most appropriate drug for individual patient on the basis of strategic decision of the risk-benefit ratio...
November 14, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/29128586/contraception-pregnancy-and-peripartum-experiences-among-women-with-epilepsy-in-bhutan
#2
Sheliza Halani, Lhab Tshering, Esther Bui, Sarah J Clark, Sara J Grundy, Tandin Pem, Sonam Lhamo, Ugyen Dema, Damber K Nirola, Chencho Dorji, Farrah J Mateen
INTRODUCTION: Reports on the reproductive health of women with epilepsy (WWE) in low- and middle-income countries (LMICs) are limited. Bhutan is a lower income country with a high estimated prevalence of epilepsy and no out-of-pocket payment requirements for health visits or medications. METHODS: We developed a 10-category survey to interview WWE ages 20-59 years in the Kingdom of Bhutan to understand their contraceptive use and peripartum experiences. WWE were recruited from 2016-2017 from an existing epilepsy cohort and their reproductive health data were merged with epilepsy and socioeconomic data obtained from initial clinical evaluations performed between 2014 and 2016...
December 2017: Epilepsy Research
https://www.readbyqxmd.com/read/29116720/the-croatian-model-of-integrative-prospective-management-of-epilepsy-and-pregnancy
#3
Snježana Miškov, Romana Gjergja Juraški, Ivan Mikula, Silvio Bašić, Marija Bošnjak Pašić, Vesna Košec, Zlatko Sabol, Aleksandra Fučić, Tomislav Sajko, Vanja Bašić Kes
Epilepsy is the most common neurological complication in pregnancy. Women with epilepsy have a higher risk of complications in pregnancy. In Croatia, women with epilepsy are treated by neurologists at tertiary centers according to the place of residence. We prospectively followed-up pregnancies in women with epilepsy and healthy controls, and analyzed the factors responsible for their delivery outcomes and development of their babies. Healthy pregnant women had a higher level of education and economic status, but pregnant women with epilepsy took folic acid in a higher proportion than controls, possibly due to timely preconception counseling...
December 2016: Acta Clinica Croatica
https://www.readbyqxmd.com/read/29114815/maternal-use-of-antiepileptic-agents-during-pregnancy-and-major-congenital-malformations-in-children
#4
Rebecca L Bromley, Jennifer Weston, Anthony G Marson
Clinical Question: Is maternal use of antiepileptic drugs during pregnancy associated with major congenital malformations in children? Bottom Line: Certain antiepileptic drugs were associated with increased rates of congenital malformations (eg, spina bifida, cardiac anomalies). Lamotrigine (2.31% in 4195 pregnancies) and levetiracetam (1.77% in 817 pregnancies) were associated with the lowest risk and valproate was associated with the highest risk (10.93% in 2565 pregnancies) compared with the offspring of women without epilepsy (2...
November 7, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29076416/novel-treatment-and-new-drugs-in-epilepsy-treatment
#5
Elissavet Eskioglou, M P Perrenoud, Phiilippe Ryvlin, Jan Novy
We now get benefit from more than 20 antiepileptic drugs (AEDs) in the care of people with epilepsy. Newer generation of AED is associated with a more favourable tolerability profile than older generation AEDs which makes them easier to use, despite similar efficacy. In order to define the place of newer generation AEDs in the therapy, we review here the main current guidelines about their use for a special issue concerning antiepileptic drugs in neurosurgical practice. We also discuss how to tailor the treatment with newer generation AEDs according to the patient's needs and comorbid conditions...
October 24, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/29073690/fetal-valproate-syndrome-still-a-problem-today
#6
Katharina Wiedemann, Tanja Stüber, Monika Rehn, Eric Frieauff
Introduction Fetal exposition to valproate can lead to a cluster of facial dysmorphism, congenital anomalies and neurodevelopmental retardation. Case Report In this report we describe 2 cases of fetal valproate syndrome. In the first case, the gravida had a valproate medication before and during pregnancy with additional folic acid. She delivered a male premature infant at 25+2 weeks of gestation due to preterm labor and rupture of the membranes. Physical examination showed even in the premature infant typical signs of fetal valproate syndrome with trigonocephaly, epicanthal folds, broad root of the nose, low-set ears, thin upper lip and anteverted nares...
October 2017: Zeitschrift Für Geburtshilfe und Neonatologie
https://www.readbyqxmd.com/read/29064543/effect-of-valproic-acid-administration-during-pregnancy-on-postnatal-development-of-cerebellar-cortex-and-the-possible-protective-role-of-folic-acid
#7
Saber I Shona, Ayman A Rizk, Abir O El Sadik, Hossam Y Emam, Eid N Ali
BACKGROUND: Valproic acid (VPA), one of the most important antiepileptic drugs (AEDs), is proved to be inevitable for epileptic pregnant women to limit the hazards of convulsions on the fetuses and mothers. Periconceptional folic acid supplementation was investigated to protect against several birth defects. However, its role against VPA cerebellar toxicity was not properly investigated. AIM: The present study was conducted to evaluate the protective effect of folic acid against VPA cerebellar neurotoxicity...
October 24, 2017: Folia Morphologica (Warsz)
https://www.readbyqxmd.com/read/29054513/maternal-and-fetal-outcomes-associated-with-vagus-nerve-stimulation-during-pregnancy
#8
Anne Sabers, Dina Battino, Erminio Bonizzoni, John Craig, Dick Lindhout, Emilio Perucca, Sanjeev V Thomas, Torbjörn Tomson, Frank Vajda
OBJECTIVE: To access the effect of vagus nerve stimulation (VNS) on the outcome of pregnancy. METHODS: We used the International Registry of Antiepileptic Drugs and Pregnancy (EURAP) and its network to search for women receiving adjunctive VNS during pregnancy. Data on maternal and fetal outcomes were extracted from the registry databases and outcomes were evaluated. RESULTS: Twenty-six pregnancies were identified in 25 women. All women were exposed to a relative high VNS stimulation level (mean duty cycle 18%, range 5%-51%)...
November 2017: Epilepsy Research
https://www.readbyqxmd.com/read/28931341/the-neurotoxic-effects-of-prenatal-gabapentin-and-oxcarbazepine-exposure-on-newborn-rats
#9
Zuleyha Erisgin, Bulent Ayas, Jens R Nyengaard, N Ercument Beyhun, Yuksel Terzi
AIM: Teratogenicity is a problematic issue for pregnant women because of X-ray radiation, drugs, and genetic and unknown variables. First-generation antiepileptic drugs (AED) like valproic acid are well-known teratogens for developing fetuses. However, their usage is necessary in order to prevent maternal seizures. The underlying mechanism of birth defects associated with AED exposure remains unclear and information about the neurotoxic effects of prenatal exposure to AED is still limited...
October 5, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28857118/anti-epileptic-drug-exposure-and-risk-of-foetal-death-in-utero
#10
F J E Vajda, T J O'Brien, J Graham, A A Hitchcock, C M Lander, M J Eadie
OBJECTIVE: To clarify whether anti-epileptic drug exposure during pregnancy is associated with an increased risk of intrauterine foetal death. METHODS: Analysis of data from 2064 pregnancies with known outcomes included in the Australian Register of Antiepileptic Drugs in Pregnancy, 170 of the pregnancies being unexposed to the drugs in at least the first half of pregnancy. RESULTS: The relative risk (6.46; 95% C.I. 0.90, 46.22) of intrauterine death appeared higher, though not statistically significantly higher, in drug-exposed pregnancies compared with unexposed ones (3...
August 31, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28856694/fetal-growth-and-premature-delivery-in-pregnant-women-on-antiepileptic-drugs
#11
Sonia Hernández-Díaz, Thomas F McElrath, Page B Pennell, W Allen Hauser, Mark Yerby, Lewis B Holmes
OBJECTIVE: To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery. METHODS: This study included singleton liveborn infants born to women enrolled in the North American Antiepileptic Drug Pregnancy Registry between 1997 and 2016. Data were collected prospectively through telephone interviews. The prevalence of preterm birth (<37 weeks) and small for gestational age status (SGA) among infants exposed prenatally to AEDs when used by women with epilepsy (WWE) or women without epilepsy (WWOE) was compared with that among infants unexposed to AEDs and born to WWOE...
September 2017: Annals of Neurology
https://www.readbyqxmd.com/read/28814092/flow-cytometric-examination-of-apoptotic-effect-on-brain-tissue-in-postnatal-period-created-by-intrauterine-oxcarbazepine-and-gabapentin-exposure
#12
Z Erisgin, Y Tekelioglu
OBJECTIVE: For epileptics, pregnancy contains the balance between no seizure period and antiepileptic use having the least teratogenicity risk. The purpose is to analyse with flow cytometry the apoptotic effects on postnatal brain tissue caused by prenatal use of second generation antiepileptics oxcarbazepine (OXC) and gabapentin (GBP) having different effect mechanisms. METHOD: 30 (n = 5 each group) Wistar albino male rats (45-days-old) are used. First 3 groups are exposed to OXC (100 mg/kg/day), GBP (50 mg/kg/day), and saline, respectively on the 1st-5th prenatal days (preimplantation-implantation period) while the second 3 groups are exposed to the same substances on the 6th-15th prenatal days (organogenesis), respectively...
2017: Bratislavské Lekárske Listy
https://www.readbyqxmd.com/read/28762701/epilepsy-treatment-options
#13
REVIEW
Gerald Liu, Nicole Slater, Allen Perkins
The occurrence of a single seizure does not always require initiation of antiepileptic drugs. Risk of recurrent seizures should guide their use. In adults, key risk factors for recurrence are two unprovoked seizures occurring more than 24 hours apart, epileptiform abnormalities on electroencephalography, abnormal brain imaging, nocturnal seizures, or an epileptic syndrome associated with seizures. In children, key risk factors are abnormal electroencephalography results, an epileptic syndrome associated with seizures, severe head trauma, and cerebral palsy...
July 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28758270/prescription-drug-use-during-pregnancy-in-france-a-study-from-the-national-health-insurance-permanent-sample
#14
Romain Demailly, Sylvie Escolano, Catherine Quantin, Pascale Tubert-Bitter, Ismaïl Ahmed
PURPOSE: To provide an up-to-date account of drug prescription during pregnancy in France from 2011 to 2014 using the permanent sample of the French national computerized healthcare database and with a focus on recommended supplementations, fetotoxic drugs and teratogenic drugs. METHODS: All pregnancies identified by the International Classification of Diseases, 10th Revision codes list in the hospitalization database, lasting more than 9 weeks of amenorrhea and whose delivery occurred between 01/01/2011 and 12/31/2014, were included...
July 30, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28729328/comparative-safety-of-antiepileptic-drugs-for-neurological-development-in-children-exposed-during-pregnancy-and-breast-feeding-a-systematic-review-and-network-meta-analysis
#15
Areti Angeliki Veroniki, Patricia Rios, Elise Cogo, Sharon E Straus, Yaron Finkelstein, Ryan Kealey, Emily Reynen, Charlene Soobiah, Kednapa Thavorn, Brian Hutton, Brenda R Hemmelgarn, Fatemeh Yazdi, Jennifer D'Souza, Heather MacDonald, Andrea C Tricco
OBJECTIVES: Compare the safety of antiepileptic drugs (AEDs) on neurodevelopment of infants/children exposed in utero or during breast feeding. DESIGN AND SETTING: Systematic review and Bayesian random-effects network meta-analysis (NMA). MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched until 27 April 2017. Screening, data abstraction and quality appraisal were completed in duplicate by independent reviewers. PARTICIPANTS: 29 cohort studies including 5100 infants/children...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28714604/antidepressants-antipsychotics-and-mood-stabilizers-in-pregnancy-what-do-we-know-and-how-should-we-treat-pregnant-women-with-depression
#16
REVIEW
Asher Ornoy, Liza Weinstein-Fudim, Zivanit Ergaz
Depression is generally treated with antidepressants, but may often need antipsychotics and mood stabilizers. We discuss the updated data regarding the safety in pregnancy of antidepressants and antipsychotics, except selective serotonin reuptake inhibitors, and their possible impact on the long-term development of the offspring. Several earlier studies demonstrated a slight increase in the rate of major anomalies following maternal tricyclic antidepressant treatment, but most current literature shows their relative safety in pregnancy...
July 17, 2017: Birth defects research
https://www.readbyqxmd.com/read/28672292/association-between-pregnancy-and-perinatal-outcomes-among-women-with-epilepsy
#17
Neda Razaz, Torbjörn Tomson, Anna-Karin Wikström, Sven Cnattingius
Importance: To date, few attempts have been made to examine associations between exposure to maternal epilepsy with or without antiepileptic drug (AED) therapy and pregnancy and perinatal outcomes. Objectives: To investigate associations between epilepsy in pregnancy and risks of pregnancy and perinatal outcomes as well as whether use of AEDs influenced risks. Design, Setting, and Participants: A population-based cohort study was conducted on all singleton births at 22 or more completed gestational weeks in Sweden from 1997 through 2011; of these, 1 424 279 were included in the sample...
August 1, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28657171/is-it-safe-to-use-lamotrigine-during-pregnancy-a-prospective-comparative-observational-study
#18
Orna Diav-Citrin, Svetlana Shechtman, Naama Zvi, Victoriya Finkel-Pekarsky, Asher Ornoy
BACKGROUND: Lamotrigine is a second-generation antiepileptic drug, also used as a mood stabilizer. Published data on its use in human pregnancy are largely derived from pregnancy registries. Pregnancy experience in most studies has been reassuring. However, data from the North American Antiepileptic Drug Pregnancy Registry suggested an increased risk for oral clefts. The primary objective of the study was to evaluate the rate of major anomalies after lamotrigine exposure during pregnancy compared with pregnancies of women counseled for nonteratogenic exposure (NTE)...
September 1, 2017: Birth defects research
https://www.readbyqxmd.com/read/28646257/effect-of-epilepsy-in-pregnancy-on-fetal-growth-restriction-a-systematic-review-and-meta-analysis
#19
REVIEW
Daijuan Chen, Lisha Hou, Xia Duan, Hongling Peng, Bing Peng
PURPOSE: Epilepsy is one of the most common neurological diseases during pregnancy. However, the influence of epilepsy on fetal growth is not understood. Thus, this study conducted a meta-analysis to determine the influence of epilepsy during pregnancy on fetal growth restriction (FGR). METHODS: BIOSIS, Medline, Embase, and PubMed databases were searched between January 2000 and January 2016. Without imposing language or regional restrictions, referenced articles were selected...
June 23, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28641176/epilepsy-and-pregnancy-for-healthy-pregnancies-and-happy-outcomes-suggestions-for-service-improvements-from-the-multispecialty-uk-epilepsy-mortality-group
#20
REVIEW
J P Leach, P E Smith, J Craig, M Bagary, D Cavanagh, S Duncan, A R C Kelso, A G Marson, D McCorry, L Nashef, C Nelson-Piercy, R Northridge, K Sieradzan, S Thangaratinam, M Walker, J Winterbottom, M Reuber
Between 2009 and 2012 there were 26 epilepsy-related deaths in the UK of women who were pregnant or in the first post-partum year. The number of pregnancy-related deaths in women with epilepsy (WWE) has been increasing. Expert assessment suggests that most epilepsy-related deaths in pregnancy were preventable and attributable to poor seizure control. While prevention of seizures during pregnancy is important, a balance must be struck between seizure control and the teratogenic potential of antiepileptic drugs (AEDs)...
August 2017: Seizure: the Journal of the British Epilepsy Association
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