Management of epilepsy during pregnancy: an update

Patel, Sana; Pennell, Page B.

doi:10.1177/1756285615623934

Cited by 77 publications

(61 citation statements)

References 48 publications

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“…However, current guidelines recommend avoiding valproic acid in women of childbearing potential whenever possible, due to higher risks of anatomical teratogenesis, including neural tube defects, and behavioural teratogenesis, namely impaired postnatal cognitive development and autism 17 . The broader management of epilepsy in women of childbearing potential or pregnancy is beyond the scope of this article and the reader is referred to a comprehensive review on the topic 18 …”

Section: The Management Of Epilepsymentioning

confidence: 99%

“…17 The broader management of epilepsy in women of childbearing potential or pregnancy is beyond the scope of this article and the reader is referred to a comprehensive review on the topic. 18 If seizures persist on the first AED despite up-titration to the maximally tolerated optimal dose, non-compliance should be excluded and the appropriateness of the diagnosis and treatment re-appraised (Box 4). If an AED change is indicated, switching to an alternative monotherapy carries about 15% chance of attaining seizure freedom.…”

Section: The Management Of Epilepsymentioning

confidence: 99%

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The management of epilepsy in children and adults

Perucca

Scheffer

Kiley

2018

Medical Journal of Australia

160

125

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The International League Against Epilepsy has recently published a new classification of epileptic seizures and epilepsies to reflect the major scientific advances in our understanding of the epilepsies since the last formal classification 28 years ago. The classification emphasises the importance of aetiology, which allows the optimisation of management. Antiepileptic drugs (AEDs) are the main approach to epilepsy treatment and achieve seizure freedom in about two-thirds of patients. More than 15 second generation AEDs have been introduced since the 1990s, expanding opportunities to tailor treatment for each patient. However, they have not substantially altered the overall seizure-free outcomes. Epilepsy surgery is the most effective treatment for drug-resistant focal epilepsy and should be considered as soon as appropriate trials of two AEDs have failed. The success of epilepsy surgery is influenced by different factors, including epilepsy syndrome, presence and type of epileptogenic lesion, and duration of post-operative follow-up. For patients who are not eligible for epilepsy surgery or for whom surgery has failed, trials of alternative AEDs or other non-pharmacological therapies, such as the ketogenic diet and neurostimulation, may improve seizure control. Ongoing research into novel antiepileptic agents, improved techniques to optimise epilepsy surgery, and other non-pharmacological therapies fuel hope to reduce the proportion of individuals with uncontrolled seizures. With the plethora of gene discoveries in the epilepsies, "precision therapies" specifically targeting the molecular underpinnings are beginning to emerge and hold great promise for future therapeutic approaches.

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Section: The Management Of Epilepsymentioning

confidence: 99%

Section: The Management Of Epilepsymentioning

confidence: 99%

The management of epilepsy in children and adults

Perucca

Scheffer

Kiley

2018

Medical Journal of Australia

160

125

View full text Add to dashboard Cite

show abstract

“…However, for women with chronic conditions, or women who develop a temporary febrile illness, medications which maintain maternal health can improve neonatal outcomes [2,3]. In 2008, more than 93% of pregnant women took at least one over-the-counter or prescription medication at any time during pregnancy, and more than 50% took 4 or more medications [4].…”

Section: Introductionmentioning

confidence: 99%

Placental control of drug delivery

Al-Enazy

Ali

Albekairi

et al. 2017

Advanced Drug Delivery Reviews

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The placenta serves as the interface between the maternal and fetal circulations and regulates the transfer of oxygen, nutrients, and waste products. When exogenous substances are present in the maternal bloodstream—whether from environmental contact, occupational exposure, medication, or drug abuse—the extent to which this exposure affects the fetus is determined by transport and biotransformation processes in the placental barrier. Advances in drug delivery strategies are expected to improve the treatment of maternal and fetal diseases encountered during pregnancy.

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“…The prevalence of epilepsy has been estimated to be 0.3-0.5% in pregnant women [33]. Pregnant women with epilepsy are advised to maintain antiepileptic drugs (AED) to diminish maternal and foetal disturbance joined with seizures [22].…”

Section: Introductionmentioning

confidence: 99%

Biochemical and histological study on the effect of levetiracetam on the liver and kidney of pregnant albino rats

2019

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Background: Levetiracetam is a broad-spectrum antiseizure agent and one of the most commonly prescribed drugs for epilepsy. The aim of this work was to assess the effect of levetiracetam at its therapeutic range on the liver and kidney of pregnant albino rats. Materials and methods: Forty pregnant rats were divided equally into two groups (I-II), Rats in the group I were gavaged 1.5 mL/day distilled water in two divided doses throughout pregnancy. Rats in the group II were gavaged 1.5 mL/day distilled water (containing 36 mg levetiracetam) in two divided doses throughout pregnancy. At the end of the experiment, blood samples were taken and the sera were separated and used for biochemical analysis. The kidneys and livers of both groups were excised and used for light and electron microscopic examination. Results: Treatment with levetiracetam induced undesirable histopathological changes in the liver and kidney of pregnant albino rats. These changes were in the form of distortion of the hepatic architecture, dilatation of the central and the portal veins, widening of the Bowman's spaces, thickening and disruption of the glomerular basement membrane, fusion and effacement of secondary foot processes, cytoplasmic vacuolation, and swollen mitochondria with loss of their cristae. Such changes were confirmed by alteration of certain biochemical parameters related to the liver and kidney functions. Conclusions: Levetiracetam induced deleterious effects on the liver and kidney of pregnant albino rats. Further investigations are recommended to clarify the mechanism of levetiracetam toxicity. (Folia Morphol 2019; 78, 4: 809-817)

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Management of epilepsy during pregnancy: an update

Cited by 77 publications

References 48 publications

The management of epilepsy in children and adults

The management of epilepsy in children and adults

Placental control of drug delivery

Biochemical and histological study on the effect of levetiracetam on the liver and kidney of pregnant albino rats

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