Epilepsy and pregnancy Gynae Course 2013 - Copy.ppt

7/24/2019 Epilepsy and pregnancy Gynae Course 2013 - Copy.ppt

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Sonia Khan , MD , FRCPSonia Khan , MD , FRCP


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Fertility& the issue of polycystic ovaries.

Oral contraceptive interaction.

Pregnancy & Teratogenicity. Ubdate on international epilepsy & pregnancy

registries .

Breast feeding & Perpurium.


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Oral contraceptive interactions


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Topiramate &Oral Contraceptives


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Pregnancy&Teratogenicity


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Category D

Category C


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Pregnancy & Teratogenicity

EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN

Holmes et al AES ,Boston 4-8 ,12,2009

3%2%

9.3%

5.5%

Topiramate 4.2%Phenytoin 2.9%Levetiracetam 2.4%


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EPILEPSY IN WOMENUK Register Update, AES 4-8, December 2009

5.4

LEV !"# pts$ 2.#

%&' 8! pts$ !.9


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EPILEPSY IN WOMEN


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Rep(rt () *irst-trimester e+p(sres t( eetiracetam *r(m !0/2000

t( 8/ 20!!, *(r "! preg)a)cies. #04 1ad bee) e+p(sed t(

eetiracetam i) m()(t1erap, a)d #" 1ad bee) e+p(sed t(

eetiracetam p(t1erap.2 33 i) t1e m()(t1erap gr(p 0.0$ 6!9 i) t1e p(t1erap

gr(p 5.5"$ .33 rate i) t1e p(t1erap gr(p aried b AED regime), 7it1

(7er rates 7it1 eetiracetam 7it1 am(trigi)e !.$67it1

apr(ate ".90$(r carbamaepi)e 9.#8$

With respect to MCM, levetiracetam taen in monotherap! can "e consi#ere# a

sa$er alternative to valproate $or %omen %ith epileps! o$ chil#"earin& a&e'

Levetiracetam in pregnancy: results from te !"

an# $relan# epilepsy an# pregnancy registers.

EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN

EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN


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* !,558 *irst trimester e+p(sres t( am(trigi)e, #5 i)*a)ts 7it133s 7ere (bsered. 2.2 6 is simiar t( ge)era p(pati().:)*a)ts 7it1 33s am()g !50 am(trigi)e 6 apr(ic acid

c(mbi)ati() t1erap !0.

;( c()siste)t tpe (* ma*(rmati() t1at (ccrred.;( appreciabe i)crease i) ma*(rmati() *re


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EPILEPSY IN WOMEN

223


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)ffects of *aternal )pilepsy an# +ntiepileptic Drug !se

#uring Pregnancy on Perinatal ,ealt in -ffspring:

ation/i#e0 etrospective Coort 1tu#y in inlan#.

EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN

EPILEPSY IN WOMEN


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EPILEPSY IN WOMEN


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A t(ta (* #05 m(t1ers 6 #!! c1idre) si+ t7i) pairs$ i) t1e

primar a)asis. 224 c1idre) c(mpeted " ears (* *((7-p . 3tiariate a)asis (* a c1idre) s1(7ed t1at age-" :> 7as

(7er a*ter e+p(sre t( apr(ate t1a) t( carbamaepi)e,am(trigi)e

(rp1e)t(i) .

1idre) e+p(sed t( apr(atedid p((r () measres (* erba 6

mem(r abiities c(mpared 7it1 t1(se e+p(sed t( t1e (t1er AEDs 6

() )()-erba 6 e+ectie *)cti()s c(mpared 7it1 am(trigi)ebt

)(t carbamaepi)e (r p1e)t(i)$.

?ig1 d(se apr(ate 7as -e ass(ciated 7it1 :> ,erba 6)()-erba abiit mem(ries 6 e+ectie *)cti(), bt )(t (t1er AEDsAge-" :> c(rreated 7it1 :>s at ()ger ages 6 :> impr(ed 7it1

age *(r i)*a)ts e+p(sed t( a) AED. .


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(mpared 7it1 a )(rmatie sampe rig1t-1a)ded)ess 7as ess

*res 7ere 1ig1er i) c1idre) e+p(sed t( peric()cepti()a

*(ate

@eta apr(ate e+p(sre 1as d(se-depe)de)t ass(ciati()s 7it1

redced c(g)itie abiities acr(ss a ra)ge (* d(mai)s at " ears (*

age. Redced rig1t-1a)ded)ess 6 erba s )()-erba$ abiitiesmig1t be attribtabe t( c1a)ges i) cerebra ateraisati() i)dced b

e+p(sre t( AEDs. %1e p(sitie ass(ciati() (* peric()cepti()a *(ate

7it1 :> is c()siste)t 7it1 (t1er rece)t stdies


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Na Valproate in pregnancy tied to

autism risk

. -&3:DJ

. -&3:DJ

. -&3:DJ

. -&3:DJ

. -&3:DJ

. -&3:DJ

. -&3:DJ

. -&3:DJ


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&3:DJ

22955"#4

C&b3ed - i) pr(cess

&3:DJ

22955"#4

C&b3ed - i) pr(cess

&3:DJ

22955"#4

C&b3ed - i) pr(cess

&3:DJ

22955"#4

C&b3ed - i) pr(cess

&3:DJ

22955"#4

C&b3ed - i) pr(cess

&3:DJ

22955"#4

C&b3ed - i) pr(cess

&3:DJ

22955"#4

C&b3ed - i) pr(cess

&3:DJ

22955"#4

C&b3ed - i) pr(cess

!29 si)get() preg)a)cies 7it1 ie birt1s *r(m 9/!999 t( !0/ 20!0 i) !0"

7(me) 7it1 epieps () AED t1erap, rec(rded 7it1i) t1e *rame7(r= (* t1e

EURA& i)Astria 7ere stdied. ccrre)ce (* B ! %S dri)g preg)a)c 7as ass(ciated 7it1 a s1(rter A

7it1 5 times 1ig1er preterm ris= 6 redced birt1 7eig1t m(re i) b(s.

:) primipara, 71e) c(mpared t( mtipara, %S B ! sig)i*ica)t redced t1e

A 6 raised t1e i)cide)ce (* (7 birt1 7eig1t LHI$ i) )e()ates.AEDs p(t1erap sig)i*ica)t i)creased t1e ris= *(r sma-*(r-gestati()a-age

regardi)g 7eig1t a)d/(r e)gt1 SAI/L$

+e-eval)atin& the nee# $or #r)& therap! in partic)lar pol!therap!, maintainin&sei.)re control $or a &iven perio# "e$ore pre&nanc! an# co)nselin& a"o)t the

importance o$ preventin& /CS mi&ht improve pre&nanc! o)tcome in %omen %ith

epileps!'

enerali4e# tonicclonic sei4ures & +)Ds

#uring pregnancy


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Predictors of seizures

during pregnancy in

women with epilepsy


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Breast feeding & Perpurium


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+)D *il6 c. 7Plasma c . 8% *il6 to plasma ratio

alproate 3% ;.;;.

ar>itone =;% ;.=;.?

Car>ama4ipine =5% ;.=;.?

-@car>ama4ipine 5;% ;.5

Primi#one ';% ;.A;.9

Penytoin 2;% ;.;.5

)tosu@imi#e 9;% ;.'

Topiramate ;2;% ;.'?



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Epilepsy and pregnancy Gynae Course 2013 - Copy.ppt

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