A 26 yearold woman with epilepsy is considering becoming pregnancy

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A 26 year-old woman with epilepsy is considering
becoming pregnancy

• Supischa Theerasasawat

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• CC ???????????????????????????????????????????
• PI 14 ?????? ????????????????? complex partial
  ???? 1-2 ????????????? ????? carbamazepine
  ??????????????????????????? ??????????????????????
  ????
• 2 ?????? ??????????????????????
  generalized tonic-clonic ?????valproate ?????
  ?????????????????????????????? ???????????????????
  ?????????????
• PE - WNL

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• ????????????????????????????????????????????

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• ??????????????????
• Higher risk for congenital malformation (1-2 vs
  3-5)
• ????????????
• ???????????????????????????? 90

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????????????

• ????????????
• Teratogenic effect

• ????????????????????
• ??????????????????????????????????????????????????
  ?????

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Discontinue

• Balance against the risk and danger of seizure
  recurrent
• Etiologic factor and neurologic status
• recur remote symptomaticgtidiopathic
• Age
• Recur adultgt children
• Seizure type
• Absence epilepsy good prognosis, JME poor
  prognosis
• Duration of therapy
• 2y of therapy 4 y
• Method of withdrawal

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Discontinue in woman

• Seizure free for at least 4 years or only
  simple/complex partial seizures and does not have
  primary generalized epilepsy and tonic-clonic
  seizures

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Monotherapy vs polytherapy

• Risk fetal malformation
• One AED 3-5
• gt2 AEDs 15

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Which AED during pregnancy ?

• Teratogenic effect
• the greatest risk valproate 10
• Cognitive function

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Potential toxic effects of AEDs
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Fetal hydantoin syndrome
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Which AED during pregnancy?

• Localization-related epilesy ? carbamazepine and
  lamotrigine (lt 200 mg/d)
• Generalized epilepsy ? levetriacetam

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• Sexuality
• Fertility
• Contraception
• Pregnancy
• Breastfeeding

• Pharmacokinetic change
• Menopause
• Bone health

Choice of medication
Childbearing age
Elderly age
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Sexuality

• Sexual dysfunction 20-30
• Marked decrease in sexual interest
• Orgasmic dysfunction
• Association
• Temporal lobe
• Enzyme inducing AEDs

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Fertility

• Reduced
• Anovulatory cycles
• Hyperandrogenism
• Psychosocial factors

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Methods of contraception and antiepileptic drugs
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Antiepileptic drugs and hormonal contraception
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Pharmacokinetic changes
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Breastfeeding

• The total amounts of drug transferred to the
  infant via breast milk are usually much smaller
  than the amounts transferred via the placenta
  during pregnancy
• High transfer via breast milk zonisamide,
  ethosuximide
• Slow elimination phenobarbital, primidone,
  lamotrigine
• Monitor is recommended - phenobarbital,
  primidone, lamotrigine

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Menopause

• A third no change in seizure frequency, 27
  decrease, 40 increase (especially associate with
  hormone replacement therapy)

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Bone health

• Increased risk of fractures, osteoporosis and
  osteomalacia
• Adverse effects of AEDs (barbiturates, phenytoin,
  carbamazepine and valproate) on bone metabolism,
  vitamin D and bone turnover
• Women taking long-term AEDs should have bone
  density monitored on a regular basis.

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The most appropriate treatment strategy

• Continue current therapy with carbamazepine and
  valproate
• Discontinue both antiepileptic drugs
• Suggest that she not become pregnant
• Discontinue valproate and continue carbamazepine