Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Mostrar biografía de los autores
La epilepsia es la entidad neurológica que con mayor frecuencia requiere tratamiento continuo durante la gestación. Se revisan las posibles complicaciones en la madre, en que forma puede afectarse el feto y la probabilidad teratogénica de los anticonvulsivantes. Es importante programar el embarazo para elegir el medicamento adecuado siendo la época libre de crisis la más conveniente. El médico debe buscar ante todo controlar las crisis durante el embarazo y buscar que el fármaco sea el menos teratogénico, pues casi todos los anticonvulsivantes tienen efectos nocivos para el feto. El ácido valproico continúa siendo el de mayor riesgo para producir malformaciones congénitas y trastornos cognitivos detectables en la niñez. Otros medicamentos como levetiracetam, lamotrigina, carbamazepina o fenitoina han demostrado ser menos tóxicos. Debe evitarse la politerapia y administrar ácido fólico para favorecer la normalidad del embarazo y su producto.
Visitas del artículo 3055 | Visitas PDF 7953
Descargas
1. Viinikainen K, Heinonen S, Eriksson K, Kalviainen R. Fertility in women with active epilepsy. Neurology. 2007; 69(22):2107-8.
2. Schupf N, Ottman R. Likelihood of Pregnancy in Individuals with Idiopathic/Cryptogenic Epilepsy: Social and Biologic Influences. Epilepsia. 1994; 35(4):750-6.
3. O ́Connor SE, Zupanc ML. Women and epilepsy. J Pediatr Pharmacol Ther. 2009; 14(4): 212-20.
4. Crawford P, Hudson S. Understanding the information needs of woman with epilepsy al diferent lifestages: results of the ‘Ideal World’ survey. Seizure. 2003; 12(7): 502-507.
5. Harden CL Pennell PB. Neuroendocrine considerations in the treatment of : men and woman with epilepsy. Lancet Neurol. 2013; 12(1): 72–83.
6. Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol. 2011; 10(7):609-17.
7. Nariño D, Grillo MP. Epilepsia catamenial. Acta Neurol Colomb. 2005; 21(1): 25-33.
8. Harden CL, Koppel BS, Herzog AG, Nikolov, BG, Hauser WA. Seizure frequency is associated with age at menopause in women with epilepsy. Neurology. 2003; 61(4): 451-55.
9. Morell MJ. Reproductive and metabolic disorders in women with epilepsy. Epilepsia. 2003; 44(suppl 4):11–20.
10. Harden CL, Meador KJ, Pennel PB, Hauser WA, Gronseth GS et al. Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009; 73(2): 133- 141.
11. Harden CL. Pregnancy and epilepsy. Continuum (Minneap, Minn.). 2014; 20(1, Neurology of Pregnancy):60-79.
12. Walker SP, Permezel M, Berkovic SF. The manegement of epilepsy in pregnancy. BJOG. 2009; 116(6):758- 67.
13. Craig JJ, Hunt SJ. Treating women with juvenile myoclnic epilepsy. Pract Neurol. 2009; 9(5):268-77.
14. Noe KH, Pack AM. Women’s issues and epilepsy. Continuum (Minneap, Minn.). 2010; 16 (3, epilepsy): 159-78.
15. Harden CL, Pennel PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, et Al. Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009; 73(2):142-149.
16. Artama M, Isojärvi JL, Raitanen J, Auvinen A. Bird rate among patiens with epilepsy: a nationwide population-based cohort study in Finland. Am. J. Epidemiol. 2004; 159(11):1057-63.
17. Harden CL, Hopp J. Ting TY, Pennell PB, French JA, Hauser WA et al. Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009; 73 (2):126-132.
18. Pennell PB. Pregnancy in the woman with epilepsy. Maternal and fetal outcomes. Semin Neurol. 2002; 22(3): 299-308.
19. Holmes LB, Mittendorf R, Shen A, Smith CR, Hernandez-Diaz S. Fetal effects of anticonvulsivant politherapies: different risks from different drugs combinations. Arch Neurol. 2011; 68(10): 1275-81.
20. Morrow J, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R et al. Malformations risks of antiepileptic drugs in pregnancy: a prospective study from the UK epilepsy and pregnancy register. J Neurol Neurosurg psychiatry 2006; 77(2): 193-8.
21. Tran TA, Leppik IE, Blesi K, Sathanandan ST, Remmel R. Lamotrigine clearance during pregnancy. Neurology. 2002;59(2):251-5.
22. Tran TA, Leppik IE, Blesi K, Sathanandan ST, Remmel R. Lamotrigene clearence during pregnancy. Neurology. 2002; 59(2): 251-255.
23. Vajda FJ, O ́Brian TJ, Graham J, Lander CM, Eadie MJ. Associations between particular types of fetal malformation and antiepileptic drug exposure in utero. Acta Neurol Scand. 2013; 128(4): 228-234.
24. Pennel PB. Antiepileptic drugs during pregnancy: What is known and wich ADEs seem to be safest? Epilepsia. 2008; 49 sup. 9 ):43-55.
25. Meador Kj, Baker GA ,Browning N, Cohen MJ, Bromley RL, Clayton-Smith J et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013; 12 (3):244-253.
26. Meador KJ, Loring DW. Risks of in utero exposure to valproate. JAMA. 2013; 309(16):1730-31.
27. Klein AM. Epilepsy cases in pregnant and pospartum women: a practical approach. Semin Neurol. 2011; 31(4):392-396.
28. Vajda F, O’Brian T. Valproic acid use in pregnancy and congenital malformations. N Engl J Med. 2010; 363(18):1771; author reply 1771-2.
29. Jentink J, Loane MA, Dolk H, Barisic I, Garne E, Morris JK et al.. Valproic Acid monotherapy in pregnancy and major congenital malformations. N Engl J Med. 2010; 362(23): 285-293.
30. DiLiberti JH, Farndon PA, Dennis NR, Curry CJ. The fetal valproate syndrome. Am J Med Genet. 1984;19(3):473-81.
31. Martínez-Ferri M. Peña-Mayor P, López-Fraile L, Castro-Vilanova MD, Escartin A, Moro M et al. Malformaciones y muerte fetal en el registro español de fármacos antiepilépticos y embarazo: resultados a los 6 años. Neurología. 2009; 24(6): 360-365.
32. Wiszinsky DF, Nambisan M, Surve T, Alsdorf RM, Smith CR, Holmes LB. Increased rate of major malformations in offspring exposed to valproate during pregnancy. Neurology. 2005; 64(6) 961-5.
33. DiLiberti JH, Farndon PA, Dennis NR, Curry CJ. The fetal valproate syndrome. Am J Med Genet. 1984; 19(3): 473-81.
34. Winter RM, Donnai D, Burn J, Tucker SM. Fetal valproate síndrome: is there a recognisable phenotype? J Med Genet. 1987; 24(11): 692-695.
35. Kini U, Adab N, Vinten J Fryer A, Clayuton-Smith J, Group LaMNS. Dysmorfhic features: an important clue to the diagnosis and severity of fetal anticonvulsivant syndromes. Arch Dis Child Feteal Neonatal. 2006; 91(2):F90-95.
36. Holmes LB, Coull BA, Dorfman J, Rosenberger PB. The correlation of deficits in IQ with midface and digit hypoplasia in children exposed in utero to anticonvulsant drugs. The Journal of Pediatrics. 146(1):118-22 doi: 10.1016/j.jpeds.2004.08.048.
37. Vinten J, Adab N, Kini U, Gorry J, Gregg J, Baker GA, et al. Neuropsychological effects of exposure to anticonvulsant medication in utero. Neurology. 2005;64(6):949-54. doi: 10.1212/01.WNL.0000154514.82948.69.
38. Tomson T, Battino D. Teratogenic effects of antiepileptic drugs. The Lancet Neurology. 2012;11(9):803-13. doi:10.1016/S1474-4422(12)70103-5.
39. Adab N, Jacoby A, Smith D, Chadwick D. Additional educational needs in children born to mothers with epilepsy. Journal of Neurology, Neurosurgery & Psychiatry. 2001;70(1):15-21. doi:10.1136/jnnp.70.1.15.
40. Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. Jama. 2013;309(16):1696-703. doi:10.1001/jama.2013.2270.
41. Díaz-Anzaldúa A, Díaz-Martínez A. Contribución genética, ambiental y epigenética en la susceptibilidad a los trastornos del espectro autista. Rev Neurol. 2013;57(556):68.
42. Reinisch J, Sanders SA, Mortensen E, Rubin DB. In Utero Exposure to Phenobarbital and Intelligence Deficits in Adult Men. JAMA. 1995;274(19):1518-1525. doi:10.1001/jama.1995.03530190032031.
43. Beghi E, Annegers JF. Pregnancy registries in epilepsy. Epilepsia. 2001;42(11):1422-5.
44. Holmes LB, Wyszynski DF, Lieberman E. The AED (antiepileptic drug) pregnancy registry: a 6-year experience. Archives of Neurology. 2004;61(5):673-8. doi:10.1001/archneur.61.5.673.
45. Gedzelman E, Meador KJ. Antiepileptic drugs in women with epilepsy during pregnancy. Therapeutic advances in drug safety. 2012:2042098611433192. doi: 10.1177/2042098611433192.
46. Wide K, Winbladh B, Källén B. Major malformations in infants exposed to antiepileptic drugs in utero, with emphasis on carbamazepine and valproic acid: a nation-wide, population-based register study. Acta Pædiatrica. 2004;93(2):174-6. doi: 10.1111/j.1651-2227.2004.tb00701.x.
47. Jentink J, Dolk H, Loane MA, Morris JK, Wellesley D, Garne E, et al. Intrauterine exposure to carbamazepine and specific congenital malformations: systematic review and case-control study2010 2010-12-03 00:09:25. doi. 10.1136/bmj.c6581.
48. Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Seizure control and treatment changes in pregnancy: Observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013;54(9):1621-7. doi: 10.1111/epi.12302
49. Cunnington M, Ferber S, Quartey G. Effect of dose on the frequency of major birth defects following fetal exposure to lamotrigine monotherapy in an international observational study. Epilepsia. 2007;48(6):1207-10.
50. Artama M, Auvinen A, Raudaskoski T, Isojärvi I, Isojärvi J. Antiepileptic drug use of women with epilepsy and congenital malformations in offspring. Neurology. 2005;64(11):1874-8. doi:10.1212/01.WNL.0000163771.96962.1F.
51. Hernández-Díaz S, Smith C, Shen A, Mittendorf R, Hauser W, Yerby M, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78(21):1692-9. doi: 10.1212/WNL.0b013e3182574f39.
52. Hunt S, Craig J, Russell A, Guthrie E, Parsons L, Robertson I, et al. Levetiracetam in pregnancy: preliminary experience from the UK Epilepsy and Pregnancy Register. Neurology. 2006;67(10):1876-9. doi:10.1212/01.wnl.0000244491. 48937.55.
53. Mawhinney E, Craig J, Morrow J, Russell A, Smithson WH, Parsons L, et al. Levetiracetam in pregnancy Results from the UK and Ireland epilepsy and pregnancy registers. Neurology. 2013;80(4):400-5. doi: 10.1212/WNL.0b013e31827f0874.
54. Tomson T, Battino D, Craig J, Hernandez‐Diaz S, Holmes LB, Lindhout D, et al. Pregnancy registries: differences, similarities, and possible harmonization. Epilepsia. 2010;51(5):909-15.
55. Hunt S, Russell A, Smithson W, Parsons L, Robertson I, Waddell R, et al. Topiramate in pregnancy Preliminary experience from the UK Epilepsy and Pregnancy Register. Neurology. 2008;71(4):272-6. doi: 10.1212/01.wnl.0000318293.28278. 33.
56. Margulis AV, Mitchell AA, Gilboa SM, Werler MM, Mittleman MA, Glynn RJ, et al. Use of topiramate in pregnancy and risk of oral clefts. American journal of obstetrics and gynecology. 2012;207(5):405. e1-e7. doi:10.1016/j.ajog.2012.07.008.
57. Krishnamurthy KB. Managing epilepsy during pregnancy: assessing risk and optimizing care. Current treatment options in neurology. 2012;14(4):348-55. doi: 10.1007/s11940-012-0184-7.
58. Werler MM, Ahrens KA, Bosco JL, Mitchell AA, Anderka MT, Gilboa SM, et al. Use of antiepileptic medications in pregnancy in relation to risks of birth defects. Annals of epidemiology. 2011;21(11):842-50. doi: doi:10.1016/j.annepidem.2011.08.002.
59. Adab N, Kini U, Vinten J, Ayres J, Baker G, Clayton-Smith J, et al. The longer term outcome of children born to mothers with epilepsy. Journal of Neurology, Neurosurgery & Psychiatry. 2004;75(11):1575-83. doi:10.1136/jnnp.2003.029132.
60. Meador K, Pennell P, Harden C, Gordon J, Tomson T, Kaplan P, et al. Pregnancy registries in epilepsy A consensus statement on health outcomes. Neurology. 2008;71(14):1109-17. doi: 10.1212/01.wnl.0000316199.92256.af.
61. Meador K, Baker G, Browning N, Cohen M, Bromley R, Clayton-Smith J, et al. Effects of fetal antiepileptic drug exposure Outcomes at age 4.5 years. Neurology. 2012;78(16):1207-14. doi: 10.1212/WNL.0b013e318250d824.
62. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. The Lancet Neurology. 2013;12(3):244-52. doi:10.1016/S1474-4422(12)70323-X.
63. Czeizel AE. Prevention of congenital abnormalities by periconceptional multivitamin supplementation. Bmj. 1993;306(6893):1645-8. doi:10.1136/bmj.306.6893.1645.
64. Martínez-Frías ML, Rodríguez-Pinilla E, Bermejo E. Análisis de la situación en España sobre el consumo de ácido fólico/folinato cálcico para la prevención de defectos congénitos. Medicina Clínica. 2003;121(20):772-5. doi:10.1016/S00257753(03)74094-9.
65. Kaaja E, Kaaja R, Hiilesmaa V. Major malformations in offspring of women with epilepsy. Neurology. 2003;60(4):575-9. doi:10.1212/01.WNL.0000044157. 28073.DC.
66. Morrow JI, Hunt SJ, Russell AJ, Smithson WH, Parsons L, Robertson I, et al. Folic acid use and major congenital malformations in offspring of women with epilepsy: a prospective study from the UK Epilepsy and Pregnancy Register. Journal of Neurology, Neurosurgery & Psychiatry. 2009;80(5):506-11. doi:10.1136/jnnp.2008.156109.
67. Cheschier N. ACOG practice bulletin. Neural tube defects. Number 44, July 2003.(Replaces committee opinion number 252, March 2001). International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2003;83(1):123-33. doi:10 10.1016/S00207292(03)00390-4.1016/S0020-7292(03)00390-4.