SUMMARY The effect of pregnancy on seizure frequency was monitored prospectively in 136 pregnancies of 122 epileptic women. Pregnancy did not influence the seizure frequency in 68 pregnancies (50%). In 50 pregnancies (37%) the number of seizures increased during pregnancy or puerperium. The seizure frequency decreased in 18 pregnancies (13%). In 34 out of 50 pregnancies (68%) the increase was associated with non-compliance with the drug regimen or sleep deprivation. In seven out of 18 pregnancies (39%) improvement was related to correction of non-compliance or sleep deprivation during the pregestational nine months. Insufficiently low plasma concentrations of antiepileptic drugs were found in 47% of the women with uncontrolled epilepsy during pregnancy. The course of epilepsy during pregnancy is primarily influenced by non-compliance, sleep deprivation during pregnancy, and inadequate therapy before and during pregnancy. With good medical attention pregnancy itself seems to have only a minimal influence on the course of epilepsy.Improvements in the drug therapy of epilepsy have led to a growing number of well controlled epileptic women in childbearing age. It is therefore not surprising that the influence of pregnancy on the course of epilepsy has received renewed interest. According to a recent review, the seizure frequency improved in 23% and deteriorated in another 24% of 2165 pregnancies.' A number of variables may influence the seizure frequency. These include hormonal and metabolic factors, respiratory changes, psychological problems, non-compliance with the prescribed drugs regimen, changes in pharmocokinetics of antiepileptic drugs, and a modification of seizure propensity during pregnancy.' Preliminary studies suggested that non-compliance, seizure provocation, and a decrease in the plasma concentration of antiepileptic drugs may be primarily involved in the regulation of seizure frequency during pregnancy.23 Changes in seizure propensity can be studied directly in pregnant women not receiving antiepileptic drugs. The purpose of this prospective two-centre study of 136 pregnancies was to investigate changes in seizure frequency during pregnancy and to analyse clinical and pharmacological factors associated with a seizure relapse in the individual patient. Patients and MethodsA total of 136 pregnancies of 122 epileptic women were followed prospectively from 1977 to 1981 in West-Berlin, Germany and Milan, Italy. Pregnant women were excluded from the study if they had a total of less than three verified epileptic seizures, the data on the seizure frequency were incomplete or the pregnancy was ended by abortion. The patients were referred to the Epilepsy Clinic in Milan and Berlin from departments of gynaecology and neurology and gynaecologists and neurologists for pregnancy planning and during early pregnancy.23 The project was made known to them by regular distribution of information in letters and reprints. The patients were evaluated neurologically and usually seen at monthly intervals, when the history...
Analysis 1.2. Comparison 1 SSRI or SNRI versus placebo, Outcome 2 Withdrawals-any reason.. .. .. .. Analysis 1.3. Comparison 1 SSRI or SNRI versus placebo, Outcome 3 Withdrawals due to adverse events.. .. . Analysis 1.4. Comparison 1 SSRI or SNRI versus placebo, Outcome 4 Number of patients with minor adverse events. Analysis 2.1. Comparison 2 SSRI or SNRI versus another active drug (amitriptyline), Outcome 1 Migraine frequency
Since the last version of this review, the new included studies have not added high quality evidence to support the use of SSRIs or venlafaxine (a SNRI) as preventive drugs for tension-type headache. Over two months of treatment, SSRIs or venlafaxine are no more effective than placebo or amitriptyline in reducing headache frequency in patients with chronic tension-type headache. SSRIs seem to be less effective than tricyclic antidepressants in terms of intake of analgesic medications. Tricyclic antidepressants are associated with more adverse events; however, this did not cause a greater number of withdrawals. No reliable information is available at longer follow-up. Our conclusion is that the use of SSRIs and venlafaxine for the prevention of chronic tension-type headache is not supported by evidence.
AbtractBackground The process of systematically reviewing research evidence is useful for collecting, assessing and summarizing results from multiple studies planned to answer the same clinical question. The term ''systematic'' implies that the process, besides being organized and complete, is transparent and fully reported to allow other independent researchers to replicate the results, and therefore come to the same conclusions. Hundreds of new systematic reviews are indexed every year. The growing number increases the likelihood of finding multiple and discordant results. Objectives To clarify the impact of multiple and discordant systematic reviews, we designed a program aimed at finding out: (a) how often different systematic reviews are done on the same subject; (b) how often different systematic reviews on the same topic give different results or conclusions; (c) which methods or interpretation
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