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Aktuelle Neurologie 2014; 41(08): 454-460
DOI: 10.1055/s-0034-1387345
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© Georg Thieme Verlag KG Stuttgart · New York

Epilepsie und Schwangerschaft

Epilepsy and Pregnancy
M. Bengner
Vivantes Humboldt-Klinikum, Neurologie, Berlin
,
B. Schmitz
Vivantes Humboldt-Klinikum, Neurologie, Berlin
› Author Affiliations
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Publication History

Publication Date:
13 October 2014 (online)

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Zusammenfassung

Die meisten Frauen mit Epilepsie bekommen gesunde Kinder. Junge Frauen mit Epilepsie sollten jedoch frühzeitig über die Auswirkungen ihrer Medikation auf eine Schwangerschaft aufgeklärt werden. Dies sollte idealerweise bereits bei der Ersteinstellung, auf jeden Fall aber mindestens ein Jahr vor konkretem Kinderwunsch geschehen. Die günstigsten Medikamente sind nach aktuellem Kenntnisstand Lamotrigin und Levetiracetam. Valproat sollte möglichst vermieden werden, da es mit einer hohen Fehlbildungsrate der Kinder vergesellschaftet ist, die kognitive Entwicklung der Kinder beeinträchtigen kann und mit Autismus-Spektrum-Störungen verbunden ist. Möglichst sollte eine Monotherapie angestrebt werden, da die Einnahme mehr als eines Medikamentes mit einer erhöhten kindlichen Fehlbildungsrate verbunden ist. Günstig sind auch retardierte Präparate und die Einnahme in mehreren Einzeldosen. Frauen, die Antiepileptika einnehmen, sollten bereits präkonzeptionell 5 mg Folsäure täglich einnehmen, die Einnahme sollte bis zum Ende des ersten Trimenons fortgesetzt werden. Da die Serumspiegel von Lamotrigin, Levetiracetam und Oxcarbazepin in der Schwangerschaft absinken, sollten diese bereits vor der Schwangerschaft bestimmt und dann engmaschig kontrolliert werden. Häufig ist ein Aufdosieren erforderlich, um Anfälle zu vermeiden. Während der Schwangerschaft ist zudem eine frühe Ultraschallfeindiagnostik empfohlen. Sofern gynäkologisch keine Komplikationen bestehen, sollte die Entbindung als vaginale Entbindung unter üblicher, bedarfsadaptierter Schmerzmedikation geplant werden. Stillen ist auch unter Antiepileptika zu empfehlen, die Kinder sollten in der ersten Zeit auf Sedierung oder Trinkschwäche beobachtet werden. Sofern Lamotrigin, Levetiracetam oder Oxcarbazepin während der Schwangerschaft aufdosiert wurden, sollte nach der Geburt auf Überdosierungserscheinungen geachtet werden.

Abstract

Most women with epilepsy bear healthy children. However, young women with epilepsy should be aware of the impact of their antiepileptic drugs on pregnancy. Pregnancy related issues should ideally be discussed already at the start of the first drug. Pregnancies should be planned one year ahead. According to current knowledge, favourable drugs are lamotrigine and levetiracetam. Valproate should be avoided if possible. Congenital malformations are more likely if the mother took valproate during pregnancy. Valproate is also associated with lower IQ. Both effects are dose-dependent. Furthermore, prenatal valproate exposition is associated with autism spectrum disorders. If possible, women should be on a monotherapy as intake of more than one drug is associated with higher malformation rates. Women on anti-epileptic drugs should take 5 mg folate daily. Ideally folate should be started prior to conception and taken until the end of week 12 of pregnancy. Plasma levels of lamotrigine, levetiracetam and oxcarbacepine often decrease during pregnancy and should be measured regularly. These drugs often need to be up-titrated to prevent seizures. An ultrasound in week 12 – 13 to detect malformations early should be performed. In the absence of obstetric complications, delivery should be planned as vaginal birth with usual analgetics on demand. Breast-feeding can be recommended. However, newborns should be monitored closely for sedation or poor weight-gain. If lamotrigine, levetiracetam or oxcarbazepin were up-titrated during pregnancy, drug levels should be measured postnatally, as overdosing may occur.

Schlüsselwörter

Epilepsie - Schwangerschaft - Antiepileptika - Fehlbildungen - EURAP

Keywords

epilepsy - pregnancy - antiepileptic drugs - congenital malformations - eurap
 

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