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Zentralbl Gynakol 2004; 126(3): 112-118
DOI: 10.1055/s-2004-818778
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Kinderwunsch und Schwangerschaft bei Frauen mit Epilepsie

Women with Epilepsy Planning PregnancyS. Beyenburg1 , A. G. Schmutzler2
  • 1Service de Neurologie, Département des Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg
  • 2Klink für Gynäkologie und Geburtshilfe, Kinderwunschzentrum, Christian-Albrechts-Universität Kiel, Kiel
Further Information

Publication History

Publication Date:
05 July 2004 (online)

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Zusammenfassung

Die Beratung und Behandlung von Frauen mit Epilepsie und Kinderwunsch umfasst einige besondere Aspekte. Der klinische Alltag zeigt, dass nur eine Minderheit solcher Patientinnen über zentrale Themen wie Interaktion von Antiepileptika mit oralen Kontrazeptiva, Teratogenität der Medikation, Folsäureprophylaxe, Monotherapie in der niedrigst möglichen Dosierung, Stillen des Kindes und andere Besonderheiten im Schwangerschaftsverlauf aufgeklärt ist. Bei frühzeitiger Planung und Beachtung der wichtigsten Gesichtspunkte der Behandlung verläuft die Mehrzahl der Schwangerschaften von Epilepsiepatientinnen günstig. Die vorliegende Arbeit gibt aus klinischer Sicht einen Überblick über die aktuellen Fakten, die für eine rationale Therapie von epilepsiekranken Frauen mit Kinderwunsch notwendig sind.

Abstract

There are many important health issues for women with epilepsy, in particular for women of childbearing age. Recent surveys have shown that only a minority of such patients received information on important issues concerning pregnancy. Pre-pregnancy counselling should include information on interactions of antiepileptic drugs (AEDs) and oral contraceptives, risk of teratogenicity, use of folic acid, the importance of monotherapy with the lowest effective dosage of an AED, and the safety of breast feeding as well as other special aspects of epilepsy and pregnancy. Planned pregnancy and counselling before conception is crucial. With a multidisciplinary approach the majority of pregnancies will have a favourable outcome. The article addresses these issues and describes practical considerations for the counselling of women with epilepsy who are planning pregnancy.

Schlüsselwörter

Epilepsie - Schwangerschaft - Therapie - Antiepileptika - Teratogenität - Stillen

Key words

Epilepsy - pregnancy - therapy - antiepileptic drugs - teratogenicity - breast feeding

Literatur

  • 1 Autret-Leca E, Jonville-Béra A P. Vitamin K in neonates: how to administer, when and to whom.  Paediatr Drugs. 2001;  3 1-8
    PubMedGoogle Scholar
  • 2 Bauer J. Gynäkologisch relevante Aspekte in der Behandlung von Frauen mit Epilepsie.  Frauenarzt. 1997;  38 1197-1205
    PubMedGoogle Scholar
  • 3 Bar-Oz B, Nulman I, Koren G, Ito S. Anticonvulsants and breast feeding. A critical review.  Paediatr Drugs. 2000;  2 113-126
    PubMedGoogle Scholar
  • 4 Barrett C, Richens A. Epilepsy and pregnancy: report of an epilepsy research foundation workshop.  Epilepsy Res. 2003;  52 147-187
    CrossrefPubMedGoogle Scholar
  • 5 Beyenburg S, Bauer J. Neuere klinische Aspekte der neuen Antiepileptika.  Z Epileptol. 2004;  17 30-41
    CrossrefPubMedGoogle Scholar
  • 6 Beyenburg S, Bauer J. Spezifische Aspekte der Beratung und Behandlung von Frauen mit Epilepsie.  Nervenheilkunde. 2001;  20 499-505
    PubMedGoogle Scholar
  • 7 Beyenburg S, Heils A, Rösing B, Bauer J. Fakten zu Epilepsie und Schwangerschaft.  Z Epileptol. 2001;  14 123-128
    PubMedGoogle Scholar
  • 8 Beyenburg S, Stoffel-Wagner B, Bauer J, Watzka M, Blumcke I, Bidlingmaier F, Elger C E. Neuroactive steroids and seizure susceptibility.  Epilepsy Res. 2001;  44 141-153
    CrossrefPubMedGoogle Scholar
  • 9 Bolte A C, van Geijn H P, Dekker G A. Management and monitoring of severe preeclampsia.  Eur J Obstet Gynecol Reprod Biol. 2001;  96 8-20
    CrossrefPubMedGoogle Scholar
  • 10 Crawford P, Hudson S. Understanding the information needs of women with epilepsy at different lifestages: results of the ‘Ideal World’ survey.  Seizure. 2003;  12 502-507
    CrossrefPubMedGoogle Scholar
  • 11 Crawford P, Lee P. Gender difference in management of epilepsy-what women are hearing.  Seizure. 1999;  8 135-139
    CrossrefPubMedGoogle Scholar
  • 12 Crawford P. Interactions between antiepileptic drugs and hormonal contraception.  CNS Drugs. 2002;  16 263-272
    PubMedGoogle Scholar
  • 13 Duchowny M. Neurobehavioral teratogenicity in antiepileptic drugs: the new Pandora's box.  Neurology. 2004;  62 8-9
    PubMedGoogle Scholar
  • 14 Eclampsia Trial Collaborative Group . Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial.  Lancet. 1995;  345 1455-1463
    PubMedGoogle Scholar
  • 15 Fairgrieve S D, Jackson M, Jonas P, Walshaw D, White K, Montgomery T L, Burn J, Lynch S A. Population based, prospective study of the care of women with epilepsy in pregnancy.  BMJ. 2000;  321 674-675
    PubMedGoogle Scholar
  • 16 Gaily E, Kantola-Sorsa E, Hiilesmaa V, Isoaho M, Matila R, Kotila M, Nylund T, Bardy A, Kaaja E, Granstrom M L. Normal intelligence in children with prenatal exposure to carbamazepine.  Neurology. 2004;  62 28-32
    CrossrefPubMedGoogle Scholar
  • 17 Hernandez-Diaz S, Werler A M, Walker A M, Mitchell A A. Folic acid and antagonists during pregnancy and the risk of birth defects.  N Engl J Med. 2000;  343 1608-1614
    CrossrefPubMedGoogle Scholar
  • 18 Hiilesmaa V K, Bardy A, Teramo K. Obstetric outcome in women with epilepsy.  Am J Obstet Gynecol. 1985;  152 499-504
    PubMedGoogle Scholar
  • 19 Holmes L B, Harvey E A, Coull B A, Huntington K B, Khoshbin S, Hayes A M, Ryan L M. The teratogenicity of anticonvulsant drugs.  N Engl J Med. 2001;  344 1132-1138
    CrossrefPubMedGoogle Scholar
  • 20 Kaaja E, Kaaja R, Hiilesmaa V. Major malformations in offspring of women with epilepsy.  Neurology. 2003;  60 575-579
    CrossrefPubMedGoogle Scholar
  • 21 Kaaja E, Kaaja R, Matila R, Hiilesmaa V. Enzyme-inducing antiepileptic drugs in pregnancy and the risk of bleeding in the neonate.  Neurology. 2002;  58 549-553
    PubMedGoogle Scholar
  • 22 Kaplan P W. Neurologic issues in eclampsia.  Rev Neurol (Paris). 1999;  155 335-341
    PubMedGoogle Scholar
  • 23 Krauss G L, Brandt J, Campbell M, Plate C, Summerfield M. Antiepileptic medication and oral contraceptive interactions: a national survey of neurologists and obstetricians.  Neurology. 1996;  46 1534-1539
    CrossrefPubMedGoogle Scholar
  • 24 Lindhout D, Meinardi H, Meijer J W, Nau H. Antiepileptic drugs and teratogenesis in two consecutive cohorts: changes in prescription policy paralleled by changes in pattern of malformations.  Neurology. 1992;  42 (Suppl 5) 94-110
    PubMedGoogle Scholar
  • 25 Lumley J, Watson L, Watson M, Bower C. Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects.  Cochrane Database Syst Rev. 2001;  3 CD 001056
    PubMedGoogle Scholar
  • 26 McAuley J W, Anderson G D. Treatment of epilepsy in women of reproductive age. Pharmacokinetic considerations.  Clin Pharmacokinet. 2002;  41 559-579
    PubMedGoogle Scholar
  • 27 Morrell M J. Reproductive and metabolic disorders in women with epilepsy.  Epilepsia. 2003;  44 (Suppl 4) 11-20
    PubMedGoogle Scholar
  • 28 Morrow J I, Craig J J. Anti-epileptic drugs in pregnancy: current safety and other issues.  Expert Opin Pharmacother. 2003;  4 445-456
    CrossrefPubMedGoogle Scholar
  • 29 Ohman I, Vitols S, Luef G, Soderfeldt B, Tomson T. Topiramate kinetics during delivery, lactation, and in the neonate: preliminary observations.  Epilepsia. 2002;  43 1157-1160
    CrossrefPubMedGoogle Scholar
  • 30 Pennell P B. Antiepileptic drug pharmacokinetics during pregnancy and lactation.  Neurology. 2003;  61 (Suppl 2) S35-S42
    PubMedGoogle Scholar
  • 31 Pennell P B. The importance of monotherapy in pregnancy.  Neurology. 2003;  60 (Suppl 4) S31-S38
    CrossrefPubMedGoogle Scholar
  • 32 Reuber M, Elger C E. Psychogenic nonepileptic seizures: review and update.  Epilepsy Behav. 2003;  4 205-216
    CrossrefPubMedGoogle Scholar
  • 33 Sabers A, Ohman I, Christensen J, Tomson T. Oral contraceptives reduce lamotrigine plasma levels.  Neurology. 2003;  61 570-571
    CrossrefPubMedGoogle Scholar
  • 34 Samrén E B, van Duijn C M, Christiaens G C, Hofman A, Lindhout D. Antiepileptic drug regimens and major congenital abnormalities in the offspring.  Ann Neurol. 1999;  46 739-746
    CrossrefPubMedGoogle Scholar
  • 35 Sander T. Epilepsien. In: Rieß O (Hrsg). Neurogenetik. Springer, Heidelberg 1998; 119-134
    Google Scholar

Priv.-Doz. Dr. med. Stefan Beyenburg

Département des Neurosciences, Centre Hospitalier de Luxembourg

4, rue Barblé

L-1210 Luxembourg

Phone: Phone: +3 52-44 11 66 27

Fax: +3 52-44 12 89

Email: beyenburg.stefan@chl.lu

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