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
-
2
Bauer J.
Gynäkologisch relevante Aspekte in der Behandlung von Frauen mit Epilepsie.
Frauenarzt.
1997;
38
1197-1205
-
3
Bar-Oz B, Nulman I, Koren G, Ito S.
Anticonvulsants and breast feeding. A critical review.
Paediatr Drugs.
2000;
2
113-126
-
4
Barrett C, Richens A.
Epilepsy and pregnancy: report of an epilepsy research foundation workshop.
Epilepsy Res.
2003;
52
147-187
-
5
Beyenburg S, Bauer J.
Neuere klinische Aspekte der neuen Antiepileptika.
Z Epileptol.
2004;
17
30-41
-
6
Beyenburg S, Bauer J.
Spezifische Aspekte der Beratung und Behandlung von Frauen mit Epilepsie.
Nervenheilkunde.
2001;
20
499-505
-
7
Beyenburg S, Heils A, Rösing B, Bauer J.
Fakten zu Epilepsie und Schwangerschaft.
Z Epileptol.
2001;
14
123-128
-
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
-
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
-
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
-
11
Crawford P, Lee P.
Gender difference in management of epilepsy-what women are hearing.
Seizure.
1999;
8
135-139
-
12
Crawford P.
Interactions between antiepileptic drugs and hormonal contraception.
CNS Drugs.
2002;
16
263-272
-
13
Duchowny M.
Neurobehavioral teratogenicity in antiepileptic drugs: the new Pandora's box.
Neurology.
2004;
62
8-9
-
14
Eclampsia Trial Collaborative Group .
Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial.
Lancet.
1995;
345
1455-1463
-
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
-
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
-
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
-
18
Hiilesmaa V K, Bardy A, Teramo K.
Obstetric outcome in women with epilepsy.
Am J Obstet Gynecol.
1985;
152
499-504
-
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
-
20
Kaaja E, Kaaja R, Hiilesmaa V.
Major malformations in offspring of women with epilepsy.
Neurology.
2003;
60
575-579
-
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
-
22
Kaplan P W.
Neurologic issues in eclampsia.
Rev Neurol (Paris).
1999;
155
335-341
-
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
-
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
-
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
-
26
McAuley J W, Anderson G D.
Treatment of epilepsy in women of reproductive age. Pharmacokinetic considerations.
Clin Pharmacokinet.
2002;
41
559-579
-
27
Morrell M J.
Reproductive and metabolic disorders in women with epilepsy.
Epilepsia.
2003;
44 (Suppl 4)
11-20
-
28
Morrow J I, Craig J J.
Anti-epileptic drugs in pregnancy: current safety and other issues.
Expert Opin Pharmacother.
2003;
4
445-456
-
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
-
30
Pennell P B.
Antiepileptic drug pharmacokinetics during pregnancy and lactation.
Neurology.
2003;
61 (Suppl 2)
S35-S42
-
31
Pennell P B.
The importance of monotherapy in pregnancy.
Neurology.
2003;
60 (Suppl 4)
S31-S38
-
32
Reuber M, Elger C E.
Psychogenic nonepileptic seizures: review and update.
Epilepsy Behav.
2003;
4
205-216
-
33
Sabers A, Ohman I, Christensen J, Tomson T.
Oral contraceptives reduce lamotrigine plasma levels.
Neurology.
2003;
61
570-571
-
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
-
35 Sander T. Epilepsien. In: Rieß O (Hrsg). Neurogenetik. Springer, Heidelberg 1998; 119-134
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
