עשיתי חיפוש בנושא עבורך
ומצאתי מאמר שדווקא carbamazepine שהוא טגרטול, נחשב ליותר מתאים לשימוש בהרעון, לעומת תרופות אחרות BMJ. 1993 Aug 21;307(6902):492-5. Related Articles, Links Comment in: BMJ. 1993 Oct 9;307(6909):937. Epilepsy and pregnancy. O'Brien MD, Gilmour-White S. Guy's Hospital, London. PIP: According to a London physician, women with epilepsy taking antiepileptic drugs can take combined oral contraceptives (OCs). It is usual to recommend a combined OC preparation containing at least 50 mcg of estrogen (Ovran) from patients taking enzyme-inducing antiepileptic drugs; this can be increased to 60 mcg by taking 2 30 mcg pills, and if necessary to 80 mcg. To ensure that ovulation is inhibited, the blood progesterone concentration can be measured on day 21 of the 1st cycle. The higher doses of estrogen should be accompanied by higher doses of progestogen. The commonest fetal malformations are cleft lip and palate and congenital heart disease, usually septal defects. These abnormalities may be caused by all the major antiepileptic drugs. Phenytoin has been particularly implicated and may cause minor defects in up to 30% of infants and major defects in about 5%. The incidence of cleft palate and heart defects with phenytoin is 1.8% compared with 0.7% in the general population. With sodium valproate, neural tube defects occur in about 1.5% of pregnancies. Present evidence suggests that carbamazepine is the safest drug. Folic acid supplements reduce the risk of neural tube defects in women at risk, therefore women taking antiepileptic drugs who are contemplating pregnancy should be given a small folic acid supplement or a diet rich in folate. To reduce the risk of bleeding in the perinatal period, pregnant women taking enzyme-inducing antiepileptic drugs should be given oral phytomenadione (vitamin K1) 20 mg daily for at least 1 week before delivery. Vitamin K1 should be given to the newborn immediately after delivery. Only phenobarbitone and primidone might be contraindicated for breast feeding. Mothers with uncontrolled major epilepsy should not be left alone with small children. If there is already 1 sibling with epilepsy the risk of inheriting epileptic liability rises to about 10% and if both parent have epilepsy the risk is 15-20%. Publication Types: Review Review, Tutorial מצאתי עוד איזכור בנושא, אך ללא פרטים Lancet. 1991 Jun 1;337(8753):1316-7. Related Articles, Links Teratogenesis with carbamazepine. על השפעת התרופה בהריון. ומחקר אחר, שהישווה תפקוד של ילדים שנולדו לאמהות עם תרופות לאפילפסיה ומזהיר לגבי דפאלפט. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1575-83. Related Articles, Links Comment in: J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1517-8. The longer term outcome of children born to mothers with epilepsy. Adab N, Kini U, Vinten J, Ayres J, Baker G, Clayton-Smith J, Coyle H, Fryer A, Gorry J, Gregg J, Mawer G, Nicolaides P, Pickering L, Tunnicliffe L, Chadwick DW. Department of Neurological Science, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK.
[email protected] OBJECTIVES: To determine the prevalence of cognitive delay and possible associated dysmorphic features in children exposed to antiepileptic drugs (AEDs) in utero. DESIGN: Retrospective study of children born to mothers with epilepsy. SETTING: Regional epilepsy clinics in Liverpool and Manchester, UK. PARTICIPANTS: Children aged between 6 months and 16 years born to mothers with epilepsy. MAIN OUTCOME MEASURES: Structured interviews, hospital records, clinical examination, and psychometric tests (Wechsler) were used to assess exposure and intelligence quotient (IQ). Blinded assessment of photographs was used to score children with characteristic dysmorphic features. RESULTS: A total of 249 children aged 6 and over were studied: 41 were exposed to sodium valproate, 52 to carbamazepine, 21 to phenytoin, 49 to polytherapy, and 80 were unexposed. Mean verbal IQ was significantly lower in the valproate group compared to unexposed and other monotherapy groups. Multiple regression analysis showed that both valproate exposure and frequent tonic-clonic seizures in pregnancy were significantly associated with a lower verbal IQ despite adjusting for other confounding factors. There was a significant negative correlation between dysmorphic features and verbal IQ in children exposed to valproate. CONCLUSIONS: This study identifies valproate as a drug carrying potential risks for developmental delay and cognitive impairment and is the first to suggest that frequent tonic-clonic seizures have a similar effect. Our results need to be interpreted with caution given their retrospective nature. Women with epilepsy need careful counselling about individual risk benefit of AED treatment before pregnancy. מקווה שעזרתי ולא הלחצתי,
