Yıl 2020, Cilt 10 , Sayı 1, Sayfalar 111 - 115 2020-01-31

Epilepsy Treatment in Pregnant Women
Gebelerde Epilepsi Tedavisi

Aygül TANTİK PAK [1]


Epilepsy is a brain condition characterized by the recurrence of unprovoked seizures. Epilepsy affects 2% of the world population. The majority of patients with epilepsy are women of reproductive age. Management of epileptic patient during pregnancy can be difficult. Even though they give birth to healthy children most of the times (92-96%), premature birth, low birth weight, fetal and neonatal death, congenital malformations and growth retardation rate are higher in epileptic patients than normal population. Congenital malformations are 2–5 times more prevalent in children of epileptic women in comparison with the general population. Seizures and antiepileptic drugs can have a negative effect on fetus health. As the number of seizures increases in pregnancy, pregnancy outcomes are adversely affected. Many studies have shown an association between prenatal exposure to antiepileptic drugs and increased risk of both physical anomalies and neurodevelopmental impairment. For these reasons the main purpose of management of epileptic patient during pregnancy is to choose the most appropriate antiepileptic medication with lowest effective dose for the patient to gain maximum seizure control and to maintain a healthy pregnancy period with the birth of a healthy baby.

Epilepsi provake edilmeyen nöbetlerin tekrarlamasıyla oluşan bir beyin hastalığıdır. Epilepsi dünya popülasyonunun %2’sini etkilemektedir. Epilepsili hastaların büyük bir kısmı üreme çağındaki kadınlardır. Epilepsi tanılı hastaların, gebelik sürecinde yönetimi zordur. Yüksek oranda sağlıklı (%92-96) çocuk doğurmalarına rağmen, prematür doğum, düşük doğum ağırlığı, fetal ve neonatal ölüm riski, konjenital malformasyonlar ve gelişme geriliği oranları normal popülasyona göre artış göstermektedir. Genel popülasyona göre kongenital malformasyonu olan çocuk doğurma oranı epilepsi tanılı gebelerde 2-5 kat daha fazladır. Nöbetlerin kendisi ve kullanılan antiepileptik ilaçlar fetüsün sağlığını olumsuz yönde etkileyebilir. Gebelikteki nöbet sayısı arttıkça, gebelik sonuçları olumsuz olarak etkilenmektedir. Birçok çalışma antiepileptik ilaçlara doğum öncesi maruz kalma ile hem fiziksel anomaliler hem de nöro gelişimsel bozulma riski arasında bir ilişki olduğunu göstermektedir. Bu nedenlerle takip ve tedavide temel amaç; hastanın nöbet tipine uygun, en düşük dozda ilaç tedavisi altında, maksimum nöbet kontrolünün sağlanarak sağlıklı bir gebelik sürecinin sürdürülmesi ile sağlıklı bir bebeğin doğumunun sağlanması olmalıdır.

  • 1. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014; 55(4): 475-82.
  • 2. Ozdemir O, Sari ME, Kurt A, Sakar VS, Atalay CR. Pregnancy outcome of 149 pregnancies in women with epilepsy: experience from a tertiary care hospital. Interv Med Appl Sci. 2015; 7(3):108-13.
  • 3. Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, et al. Practice Parameter Update: Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding. Neurology. 2009; 73(2): 142-9.
  • 4. Razaz N, Tomson T, Wikström AK, Cnattingius S. Association between pregnancy and perinatal outcomes among women with epilepsy. JAMA Neurology. 2017; 74(8): 983-91
  • 5. Yerby MS, Kaplan P, Tran T. Risks and management of pregnancy in women with epilepsy. Cleveland Clinic Journal of Medicine. 2004; 71(1): 25-37.
  • 6. Tettenborn B, Genton P, Polon D, Epilepsy and womwn’s issues: an update. Epileptic Disorders. 2002; 4(2): 23-31.
  • 7. Crawford P. Epilepsy and pregnancy. Seizure. 2001; 10(3): 212-9.
  • 8. Vajda FJ, Hitchcock A, Graham J, O’Brien T, Lander C, Eadie M. Seizure control in antiepileptic drug-treated pregnancy. Epilepsia. 2008; 49(1): 172-6.
  • 9. Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia. 54(9): 1621-7.
  • 10. Shahla M, Hijran B, Sharif M. The course of epilepsy and seizure control in pregnant women. Acta Neurologica Belgica. 2018; 118(3): 459-64.
  • 11. The EURAP Study Group. Seizure control and treatment in pregnancy and the puerperium. Neurology. 2006; 66(3): 354-60.
  • 12. Pennell PB, Newport DJ, Stowe ZN, Helmers SL, Montgomery JQ and Henry TR. The impact of pregnancy and childbirth on the metabolism of lamotrigine. Neurology. 2004; 62(2): 292-5.
  • 13. Mazzucchelli I, Onat FY, Ozkara C, Atakli D, Specchio LM, Neve AL, et al. Changes in the disposition of oxcarbazepine and its metabolites during pregnancy and the puerperium. Epilepsia. 2006; 47(3): 504-9.
  • 14. Thangaratinam S, Marlin N, Newton S, Weckesser A, Bagary M, Greenhill L, et al. Antiepileptic drug Monitoring in PREgnancy (EMPiRE): a double-blind randomised trial on effectiveness and acceptability of monitoring strategies. Health Technology Assessment. 2018; 22(23): 1-152.
  • 15. Vajda FJE, O’Brien TJ, Graham JE, Hitchcock AA, Lander CM, and Eadie MJ. Antiepileptic drug polytherapy in pregnant women with epilepsy. Acta Neurologica Scandinavica. 2018; 138(2): 115-21.
  • 16. Güveli BT, Rosti RÖ, Güzeltaş A, Tuna EB, Ataklı D, Sencer S, et al. Teratogenicity of antiepileptic drugs. Clinic Psychopharmacology Neurosci. 2017; 15(1): 19-27.
  • 17. Annegers J, Baumgartner K. Epilepsy, antiepileptic drugs, and the risk of spontaneous abortion. Epilepsia. 1988; 29(4): 451-8.
  • 18. Bech BH, Kjaersgaard MIS, Pedersen HS, Howards PP, Sorensen MJ, Olsen J, et al. Use of antiepileptic drugs during pregnancy and risk of spontaneous abortion and stillbirth: population based cohort study. BMJ. 2014; 349: 5159.
  • 19. Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, McCorry D, Bagary M, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet. 2015; 386(10006): 1845-52.
  • 20. Vajda FJE, O'brien TJ, Graham J, Hitchcock AA, Lander CM, and Eadie MJ. Anti‐epileptic drug exposure and risk of foetal death in utero. Acta Neurologica Scandinavica. 2018; 137(1): 20-3.
  • 21. Tomson T, Battino D, Bonizzoni E, Craig JJ, Lindhout D, Perucca E, et al. Antiepileptic drugs and intrauterine death. Neurology. 2015; 85(7): 580-8.
  • 22. Thomas SV, Sindhu K, Ajaykumar B, Devi PBS, Sujamol J. Maternal and obstetric outcome of women with epilepsy. Seizure. 2009; 18(3): 163-6.
  • 23. Trivedi M, Jose M, Philip RM, Sarma PS, Thomas, SV. Spontaneous fetal loss in women with epilepsy: prospective data from pregnancy registry in India. Epilepsy Research. 2018; 146(1): 50-3.
  • 24. Christensen J, Pedersen HS, Kjaersgaard SIM, Vestergaard M, Schendel D. Apgar score in children prenatally exposed to antiepileptic drugs: a population based cohort study. BMJ Open. 2015; 5(9): 1-6.
  • 25. Meador KJ, Loring DW. Developmental effects of antiepileptic drugs and the need for improved regulations. Neurology. 2015; 86(3): 296-307.
  • 26. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005; 46(9): 117-24.
  • 27. Barret C, Richens A. Epilepsy and pregnancy: report of an epilepsy research foundation workshop. Epilepsy Research. 2003; 52(3): 147-87.
  • 28. Genton, P, Semah, F, Trinka, E. Valproic acid in epilepsy. Drug Safety. 2006; 29(1): 1-21.
  • 29. Hernández-Díaz S, Smith CR, Shen A, Mittendorf R, Hauser WA, Yerby M, Holmes LB. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012; 78(21): 1692-9.
  • 30. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al, Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. The Lancet Neurology. 2013; 12(3): 244-52.
  • 31. Bromley R, Weston J, Adab N, Greenhalgh J, Sanniti A, McKay AJ, et al. Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. Cochrane Database of Systematic Reviews. 2014. 10. https://doi.org/10.1002/14651858.CD010236.pub2.
  • 32. European Medicines Agency [Internet]. PRAC recommends new measures to avoid valproate exposure in pregnancy 2018 [Cited: May 7, 2018]. Available from: http://www.ema.europa.eu/ema/ index.jsp?curl=pages/news_and_events/news/2018/02/news_detail_002903.jsp&mid=WC0b01ac058004d5c1.
  • 33. Morrow J, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R, et al. Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK epilepsy and pregnancy register. Journal Neurology Neurosurgery Psychiatry. 2006; 77(2): 193-8.
  • 34. Hernandez-Diaz S, Smith CR, Wyzszynski D, Holmes LB. Risk of major malformations among infants exposed to carbamazepine during pregnancy. Birth Defects Research (Part A). Proceedings of the 47th Annual Meeting of the Teratology Society; 2007 June 23-28; Pittsburgh, Pennsylvania; USA: Wiley; 2007. p. 357.
  • 35. Thomas SV, Ajaykumar B, Sindhu K, Francis E, Namboodiri N, Sivasankaran S, et al. Cardiac malformations are increased in infants of mothers with epilepsy. Pediatric Cardiology. 2008; 29(3): 604-8.
  • 36. Cunnington M, Tenis P. Lamotrigine and the risk of malformations in pregnancy. Neurology. 2005; 64(6): 955-60.
  • 37. Fujii H, Goel A, Bernard N, Pistelli A, Yates LM, Stephens S, et al. Pregnancy outcomes following gabapentin use: results of a prospective comparative cohort study. Neurology. 2013; 80(17): 1565-70.
  • 38. Hernandez-Diaz S, Mittendorf R, Holmes LB. Comparative safety of topiramate during pregnancy. Birth Defects Research (Part A). Proceedings of the 50th Annual of Teratology Society Meeting; 2010 June 26-30; Louisville, Kentucky. USA: Wiley. p. 408.
  • 39. Holmes LB, Smith CR, Hernandez-Diaz S. Pregnancy registries: Larger samples sizes essential. Birth Defects Research (Part A). Proceedings of the 48th Annual Meeting of the Teratology Society; 2008 June 28-July 2; Monterey, CA. USA: Wiley. p. 307.
Birincil Dil tr
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Derlemeler
Yazarlar

Orcid: 0000-0002-7414-3800
Yazar: Aygül TANTİK PAK (Sorumlu Yazar)
Kurum: GAZİOSMANPAŞA TAKSİM EĞİTİM VE ARAŞTIRMA HASTANESİ
Ülke: Turkey


Tarihler

Yayımlanma Tarihi : 31 Ocak 2020

Bibtex @derleme { duzcesbed627171, journal = {Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi}, issn = {}, eissn = {2146-443X}, address = {}, publisher = {Düzce Üniversitesi}, year = {2020}, volume = {10}, pages = {111 - 115}, doi = {10.33631/duzcesbed.627171}, title = {Gebelerde Epilepsi Tedavisi}, key = {cite}, author = {TANTİK PAK, Aygül} }
APA TANTİK PAK, A . (2020). Gebelerde Epilepsi Tedavisi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi , 10 (1) , 111-115 . DOI: 10.33631/duzcesbed.627171
MLA TANTİK PAK, A . "Gebelerde Epilepsi Tedavisi". Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 (2020 ): 111-115 <https://dergipark.org.tr/tr/pub/duzcesbed/issue/52090/627171>
Chicago TANTİK PAK, A . "Gebelerde Epilepsi Tedavisi". Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 (2020 ): 111-115
RIS TY - JOUR T1 - Gebelerde Epilepsi Tedavisi AU - Aygül TANTİK PAK Y1 - 2020 PY - 2020 N1 - doi: 10.33631/duzcesbed.627171 DO - 10.33631/duzcesbed.627171 T2 - Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi JF - Journal JO - JOR SP - 111 EP - 115 VL - 10 IS - 1 SN - -2146-443X M3 - doi: 10.33631/duzcesbed.627171 UR - https://doi.org/10.33631/duzcesbed.627171 Y2 - 2019 ER -
EndNote %0 Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi Gebelerde Epilepsi Tedavisi %A Aygül TANTİK PAK %T Gebelerde Epilepsi Tedavisi %D 2020 %J Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi %P -2146-443X %V 10 %N 1 %R doi: 10.33631/duzcesbed.627171 %U 10.33631/duzcesbed.627171
ISNAD TANTİK PAK, Aygül . "Gebelerde Epilepsi Tedavisi". Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 / 1 (Ocak 2020): 111-115 . https://doi.org/10.33631/duzcesbed.627171
AMA TANTİK PAK A . Gebelerde Epilepsi Tedavisi. DÜ Sağlık Bil Enst Derg. 2020; 10(1): 111-115.
Vancouver TANTİK PAK A . Gebelerde Epilepsi Tedavisi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2020; 10(1): 115-111.