- Беременность у женщин с эпилепсией
Беременность у женщин с эпилепсией
HEALTH OF WOMAN. 2017.8(124):61–64; doi 10.15574/HW.2017.124.61
Меликова Шахла Ягуб гызы
Азербайджанский Медицинский Университет, г. Баку
Эпилепсия является одним из наиболее распространенных серьезных неврологических заболеваний. Изучено множество публикаций, касающихся взаимовлияния эпилепсии и беременности. Женщины с эпилепсией испытывают ряд физических и социальных проблем, связанных с акушерским риском, риском приступов во время беременности. Генерализованные эпилептические припадки могут оказать прямое повреждающее воздействие на плод, хотя нет убедительных данных в пользу достоверного повышения частоты развития осложнений при беременности у женщин с эпилепсией. Антенатальное воздействие антиэпилептических препаратов, особенно в высокой дозе и в режиме политерапии, увеличивает риск развития врожденных мальформаций. Существуют опасения, связанные с воздействием противоэпилептических препаратов на младенца во время грудного вскармливания. Однако риск осложнений, связанных как с самим заболеванием, так и с воздействием антиэпилептических препаратов на плод, может быть снижен при условии тщательного совместного наблюдения неврологом-эпилептологом и акушером-гинекологом.
Ключевые слова: беременность, антиэпилептические препараты, эпилепсия, монотерапия, политерапия.
Литература:
1. Карлов В.А. Эпилепсия у детей и взрослых женщин и мужчин // Руководство для врачей. – М.:ОАО « Издательство Медицина», 2010. – 720 с.
2. Магалов Ш.И. (2014). Эпилепсия: 160.
3. Abe K, Hamada H, Yamada T, Obata-Yasuoka M, Minakami H, Yoshikawa H. 2014. Impact of planning of pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and neonatal outcomes. Seizure 23;2:112–116. https://doi.org/10.1016/j.seizure.2013.10.003; PMid:24183922
4. Adab N, Ayres J, Baker G et al. 2004. The longer term outcomes of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 75:1575–1583. https://doi.org/10.1136/jnnp.2003.029132; PMid:15491979 PMCid:PMC1738809
5. Aguglia U, Barboni G, Battino D, Cavazzuti GB, Citernesi A, Corosu R, Guzzetta FM, Iannetti P, Mamoli D, Patella A, Pavone L, Perucca E et al. 2009, Jan. Italian consensus conference on epilepsy and pregnancy, labor and puerperium. Epilepsia. 50; Suppl 1:7–23. https://doi.org/10.1111/j.1528-1167.2008.01964.x; PMid:19125842
6. Battino D, Tomson T, Bonizzoni E et al. 2013. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia. 54(9):1621–1627. https://doi.org/10.1111/epi.12302; PMid:23848605
7. Borthen I, Eide MG et al. 2010. Delivery outcome of women with epilepsy: a population-based cohort study. An International Journal of Obstetrics and Gynecology: 1537–1543.
8. Borthen I, Eide MG, Daltveit AK, Gilhus NE. 2011, Jul. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG. 118(8):956–65. https://doi.org/10.1111/j.1471-0528.2011.03004.x; PMid:21557799
9. Cagnetti C, Lattanzi S, Foschi N, Provinciali L, Silvestrini M. 2014. Seizure course during pregnancy in catamenial epilepsy. Neurology 83(4):339–344. https://doi.org/10.1212/WNL.0000000000000619; PMid:24944265
10. Christensen J, Sabers A, Sidenius P. 2006. Oxcarbazepine concentrations during pregnancy: a retrospective study in patients with epilepsy. Neurology 67:1497–1499. https://doi.org/10.1212/01.wnl.0000240047.11166.0e; PMid:17060586
11. Crawford P and Hudson S. 2003. Understanding the information needs of women with epilepsy at different life stages: results of the ‘Ideal World’ survey. Seizure 12:502–7. https://doi.org/10.1016/S1059-1311(03)00085-2
12. Crawford P. 2001. CPD-education and self-assessment: epilepsy and pregnancy. Seizure. 10:212–219. https://doi.org/10.1053/seiz.2001.0562; PMid:11437622
13. De Haan GJ, Edelbroek P, Segers J, Engelsman M, Lindhout D, Devile-Notschaele M, Augustijn P. 2004. Gestation-induced changes inlamotrigine pharmacokinetics: a monotherapy study. Neurology 63:571–573. https://doi.org/10.1212/01.WNL.0000133213.10244.FD; PMid:15304599
14. Edey S, Moran N, Nashef L. 2014. SUDEP and epilepsy-related mortality in pregnancy. Epilepsia 55(7):72–274. https://doi.org/10.1111/epi.12621; PMid:24754364
15. EURAP Study. Seizure control and treatment in pregnancy: Observations from the EURAP Epilepsy Pregnancy Registry. 2006. Neurology 66:354–360.
16. Harden CL. 2008. Antiepileptic drug teratogenesis: what are the risks for congenital malformations and adverse cognitive outcomes? Int Rev Neurobiol. 83:205–13. https://doi.org/10.1016/S0074-7742(08)00011-1
17. Harden CL, Meador KJ, Pennell PB. 2009. Management issues for women with epilepsy – Focus on pregnancy (an evidence based review): II. Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia 50:1237–1246. https://doi.org/10.1111/j.1528-1167.2009.02129.x; PMid:19507301
18. Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Allen Hauser W. 2009. Practice parameter update: management issues for women with epilepsy – focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 73:126–132. https://doi.org/10.1212/WNL.0b013e3181a6b2f8; https://doi.org/10.1212/WNL.0b013e3181a6b325; https://doi.org/10.1212/WNL.0b013e3181a6b312
19. Holmes LB, Harvey EA, Coull BA et al. 2001. The teratogenicity of anticonvulsant drugs. N Engl J Med 344:1132–1138. https://doi.org/10.1056/NEJM200104123441504; PMid:11297704
20. Hosie AM, Wilkins ME, Silva HM, Smart TG. 2006. Endogenous neuro-steroids regulate GABA-A receptors through two discrete transmembrane site. Nature 444(7118):486–489. https://doi.org/10.1038/nature05324; PMid:17108970
21. Hvas CL, Henriksen TB, Ostergaard JR, Dam M. 2000. Epilepsy and pregnancy: effect of antiepileptic drugs and lifestyle on birthweight. Br J Obstet Gynaecol 107:896–902. https://doi.org/10.1111/j.1471-0528.2000.tb11089.x
22. Johannessen SI, Helde G, Brodtkorb E. 2005, May. Levetiracetam concentrations in serum and in breast milk at birth and during lactation. Epilepsia 46(5):775–7. https://doi.org/10.1111/j.1528-1167.2005.54804.x; PMid:15857447
23. Kaneko S. 2000. Epilepsy, pregnancy, and the child. Epilepsia 41(9):8–13. https://doi.org/10.1111/j.1528-1157.2000.tb02211.x; PMid:11156513
24. Kaplan PW. 2004. Reproductive health effects and teratogenicity of antiepileptic drugs. Neurology 63(Suppl 4):13–23. https://doi.org/10.1212/WNL.63.10_suppl_4.S13
25. Kim JS, Kondratyev A, Tomita Y, Gale K. 2007. Neurodevelopmental impact of antiepileptic drugs and seizures in the immature brain. Epilepsia 48(Suppl 5):19–26. https://doi.org/10.1111/j.1528-1167.2007.01285.x; PMid:17910577
26. La Neve A, Boero G, Francavilla T, Plantamura M, De Agazio G, Specchio LM. 2015. Prospective, case-control study on the effect of pregnancy on seizure frequency in women with epilepsy. Neurol Sci. 36(1):79–83. https://doi.org/10.1007/s10072-014-1908-0; PMid:25070383
27. Legros B, Bottin P, de Borchgrave V, Delcourt C, de Tourtchaninoff M et al. 2003. Therapeutic issues in women with epilepsy. Acta Neurol. Belg. 103(3):135–139. PMid:14626692
28. Mani SK. 2003. Signalinq mechanisms in progesterone-neurotransmitter interactions. J. Mol. Endocrinol. 30:127–137. https://doi.org/10.1677/jme.0.0300127; PMid:12683937
29. Morrell MJ. 2002, Oct 15. Epilepsy in women. Am Fam Physician. 66(8):1489–94. PMid:12408423
30. Ohman I, Vitols S, Tomson T. 2000. Lamotrigine in pregnancy: pharmacokinetics during delivery, in the neonate and during lactation. Epilepsia 41:709–713. https://doi.org/10.1111/j.1528-1157.2000.tb00232.x; PMid:10840403
31. Ornoy A, Zvi N, Arnon J et al. 2008. The outcome of pregnancy following topiramate treatment: a study on 52 pregnancies. Reprod Toxicol. 25(3):388–389. https://doi.org/10.1016/j.reprotox.2008.03.001; PMid:18424066
32. Ornoy A. 2009. Valproic acid in pregnancy: how much are we endangering the embryo and fetus? Reprod Toxicol. 28(1):1–10. https://doi.org/10.1016/j.reprotox.2009.02.014; PMid:19490988
33. Ozdemir O, Sari M, Kurt A et al. 2015, Sep. Pregnancy outcome of 149 pregnancies in women with epilepsy: Experience from a tertiary care hospital. Interv Med Appl Sci. 7(3):108–113. https://doi.org/10.1556/1646.7.2015.3.4; PMid:26527567 PMCid:PMC4609022
34. Pennell PB. 2003, Sep 1. Antiepileptic drug pharmacokinetics during pregnancy and lactation. Neurology 61(6 Suppl 2):S35–42. https://doi.org/10.1212/WNL.61.6_suppl_2.S35; PMid:14504308
35. Pennell PB. 2002, Sep. Pregnancy in the woman with epilepsy: maternal and fetal outcomes. SeminNeurol. 22(3):299–308. https://doi.org/10.1055/s-2002-36649; PMid:12528055
36. Perucca E. 2005. Birth defects after prenatal exposure to antiepileptic drugs. Lancet Neurol. 4(11):781–6. https://doi.org/10.1016/S1474-4422(05)70224-6
37. Petrenaite V, Sabers A, Hansen-Schwartz J. 2005. Individual changes inlamotrigine plasma concentrations during pregnancy. Epilepsy Res. 65:185–188. https://doi.org/10.1016/j.eplepsyres.2005.06.004; PMid:16084694
38. Petrenaite V, Sabers A, Hansen-Schwartz J. 2009. Seizure deterioration in women treated with oxcarbazepine during pregnancy. Epilepsy Res. 84:245–249. https://doi.org/10.1016/j.eplepsyres.2009.01.011; PMid:19231139
39. Pilo C, Wide K, Winbladh B. 2006. Pregnancy, delivery, and neonatal complications after treatment with antiepileptic drugs. Acta Obstet Gynecol Scand 85:643–646. https://doi.org/10.1080/00016340600604625; PMid:16752253
40. Reimers A, Helde G, Brathen G, Brodtkorb E. 2011. Lamotrigine and itsN2-glucuronide during pregnancy: the significance of renal clearance and estradiol. Epilepsy Res. 94:198–205. https://doi.org/10.1016/j.eplepsyres.2011.02.002; PMid:21356585
41. Richmond JR, Krishnamoorthy P, Andermann E, Benjamin A. 2004, Feb. Epilepsy and pregnancy: an obstetric perspective. Am J Obstet Gynecol. 190(2):371–9. https://doi.org/10.1016/j.ajog.2003.09.020; PMid:14981376
42. Ried S, Beck-Mannagetta G. 1996. Epilepsy, pregnancy and the child. Blackwell Science 82.
43. Shinnar S, Pellock JM. 2002, Jan. Update on the epidemiology and prognosis of pediatric epilepsy. J Child Neurol. 17; Suppl 1:S4–17. https://doi.org/10.1177/08830738020170010201; PMid:11918462
44. Sveberg L, Svalheim S, Taubøll E. 2015. The impact of seizures on pregnancy and delivery. Seizure 28:35–38. https://doi.org/10.1016/j.seizure.2015.02.020; PMid:25746572
45. Thomas SV, Nair RR, Jose M, Sarma PS. 2009. Risk of major congenital malformations in the offsprings of women with epilepsy is not related to family history. Epilepsy Res. 83(1):52–7. https://doi.org/10.1016/j.eplepsyres.2008.09.002; PMid:18977119
46. Thomas SV. 2006, March. Management of epilepsy and pregnancy. J Postgrad Med 52;Issue 1:57–64. PMid:16534170
47. Thomas SV, Syam U, Devi JS. 2012, May. Predictors of seizures during pregnancy in women with epilepsy. Epilepsia 53(5):85–8. https://doi.org/10.1111/j.1528-1167.2012.03439.x; PMid:22429269
48. Tomson T, Battino D. 2009. Teratogenic effects of antiepileptic medications. Neurol Clin. 27(4):993–1002. https://doi.org/10.1016/j.ncl.2009.06.006; PMid:19853219
49. Tomson T, Battino D. 2005. Teratogenicity of antiepileptic drugs: state of the art. Curr Opin Neurol 18:135–140. https://doi.org/10.1097/01.wco.0000162854.67767.06; PMid:15791143
50. Tomson T, Battino D. 2007. Pharmacokine-tics and therapeutic drug monitoring of newer antiepileptic drugs during pregnancy and the puerperium. Clin Pharmacokinet. 46(3):209–19. https://doi.org/10.2165/00003088-200746030-00002; PMid:17328580
51. Tomson T. 2012. Teratogenic effects of antiepileptic drugs. Lancet Neurol 11:803–813. https://doi.org/10.1016/S1474-4422(12)70103-5
52. Tomson T, Johannessen C and Battino D. 2013. Antiepileptic drug treatment in pregnancy: Changes in drug disposition and their clinical implications. Epilepsia 54(3):405–414. https://doi.org/10.1111/epi.12109; PMid:23360413
53. Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A, Perucca E, Vajda F. 2011. EURAP study group. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol. 10(7):609–17. https://doi.org/10.1016/S1474-4422(11)70107-7
54. Tomson Т, Xue H, Battino D. 2015. Major congenital malformations in children of women with epilepsy. Seizure 28:46–50. https://doi.org/10.1016/j.seizure.2015.02.019; PMid:25777785
55. Vajda FJE, Hitchcock A, Graham J et al. 2008. Seizure control in antiepileptic drug- treated pregnancy. Epilepsia 49(1):172–176. https://doi.org/10.1111/j.1528-1167.2007.01412.x; PMid:18031551
56. Veiby G, Bjørk M, Engelsen BA, Gilhus NE. 2015, May. Epilepsy and recommendations for breastfeeding. Seizure 28:57–65. https://doi.org/10.1016/j.seizure.2015.02.013; PMid:25837494
57. Vlasov PN, Karlov VA, Petrukhin VA. 2013. Эпилепсия и беременность: современная терапевтическая тактика. Неврология, нейропсихиатрия, психосоматика. 5(1):13–17.
58. Viinikainen K, Heinonen S, Eriksson K, Kalviainan R. 2006. Community-based, prospective, controlled study of obstetric and neonatal outcome of 179 pregnancies in women with epilepsy. Epilepsia 47:186–192. https://doi.org/10.1111/j.1528-1167.2006.00386.x; PMid:16417548
59. Yerby M. 2000. Quality of life, epilepsy advances, and the evolving role of anticonvulsants in women with epilepsy. Neurology 55(suppl 1):21–31.