14 Surveillance of Croatian pregnant women with epilepsy and effects of antiepileptic drugs exposure in their offspring

Abstract

In selected illustrative cases we present imaging findings characteristic for different pathological white matter processes. Conclusion: MRI is a very sensitive but unfortunately relatively unspecific method for evaluation of WML. As mentioned earlier, differential diagnosis of WML is a long list. Due to that the diagnosis of a specific pathological process characterised by one or more lesions in the white matter has to be made by combining clinical aspect and radiological assessment.

Dose Monitoring of Lamotriginxe Monotherapy in Pregnancy: Are Pregnant Women with Epilepsy Currently Optimally Managed? A Systematic Review

“…There were 6 prospective studies (4 observational studies, 12,23,28,29 1 observational survey, 10 and 1 doubleblind randomized trial), 30 4 retrospective studies, [31][32][33][34] and 1 study combining both prospective and retrospective aspects (Table 1). 35 The sample size varied across the studies, ranging from 12 to 1251 participants.…”

“…35 The sample size varied across the studies, ranging from 12 to 1251 participants. Among these studies, 5 exclusively focused on patients receiving lamotrigine monotherapy, 10,12,23,31,35 2 involved patients on different antiepileptic drugs, including lamotrigine monotherapy, 28,33 and 4 included a combination of patients on either lamotrigine monotherapy or combination therapy. 29,30,32,34 From these studies, only lamotrigine-specific data were extracted, if available.…”

“…com/TDM/A719). The high-risk studies were primarily impacted by confounding variables (eg, smoking), recall bias, 10 and missing data. 28 The unclear risk was because of potential confounding variables and insufficient explanation of the measurement of serum lamotrigine levels in the study.…”

“…In all studies, daily lamotrigine dosage and/or maternal serum levels were analyzed (Table 2). Data on the daily prepregnancy doses were available for 4 studies, 10,28,31,34 whereas data on the daily dose during pregnancy were available for 5 studies. 10,[28][29][30]34 In 2 studies, the mean prepregnancy doses were 92.86 (range: 50-150) mg/d 31 and 100 mg/d (extrapolated from the graph).…”

“…5 In cases where a woman is receiving teratogenic antiepileptic drugs such as valproic acid, it is recommended to switch to lamotrigine before planning a pregnancy, and conception should be delayed for at least 2 months after the treatment change. 10 Experts have recommended therapeutic drug monitoring (TDM) to better guide lamotrigine dose adjustment during pregnancy. 11,12 However, routine monitoring is not widely practiced owing to limited evidence supporting its impact on clinical outcomes.…”