Use of valproates in women of childbearing age and pregnant women with epilepsy
https://doi.org/10.14412/2074-2711-2015-1S-4-9
Abstract
The paper considers the specificity of using valproic acid (VA) preparations in young childbearing-aged women with epilepsy and discusses the clinical situations of practical application of valproates during pregnancy in view of the baseline efficiency of therapy, the type of epileptic seizures, and the form of epilepsy. It provides a few scenarios of the course of pregnancy and possible treatment policy. Owing to its multiple mechanism of action, VA has been effectively used to treat idiopathic (generalized/focal) cryptogenic and symptomatic focal epilepsies in patients of different age groups, including in childbearing-aged women. It is also effectively used to treat manias in the pattern of bipolar disorders and to prevent migraine. The range of action (the efficiency against different types of seizures and forms of epilepsy), good tolerance, a minimal aggravation risk, high continuous therapy rates, various drug dosage forms, including long-acting or intravenous formulatons, and favorable pharmacokinetic and pharmacodynamics profiles make VA indispensable at the present developmental stage of epileptology. However, VA has definite limitations: the drug is contra-indicated in some forms of mitochondrial encephalopathies; its prescription to young women requires comprehensive assessment of possible therapy consequences, especially in pregnancy planning, the drug should be used with extreme caution in the first trimester of pregnancy. The ideal variant of VA prescription in young women of fertile age is monotherapy, by using its minimal effective daily dose and sustained-release formulations.
About the Author
P. N. Vlasov
Department of Nervous System Diseases, Faculty of Therapeutics, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
20, Delegatskaya St., Build. 1, Moscow 127473
Russian Federation
Russian Federation
References
1. Meador K, Reynolds MW, Crean S, et al. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008 Sep;81(1):1–13. DOI: 10.1016/j.eplepsyres.2008.04.022. Epub 2008 Jun 18.
2. Дмитренко ДВ. Профилактика врожденных пороков развития у плода с учетом фармакогенетических особенностей метаболизма противоэпилептических препаратов и наследственных нарушений фолатного цикла. Неврология, нейропсихиатрия, психосоматика. 2014(Спецвыпуск 1):31–38. [Dmitrenko DV. Prevention of fetal congenital malformations with allowance for the pharmacogenetic features of the metabolism of antiepileptic drugs and hereditary abnormalities in the folate cycle. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014(S1):31–38.(In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-27112014-1S-31-38
3. Bromley RL, Mawer G, Clayton-Smith J, Baker GA. Liverpool and Manchester Neurodevelopment Group. Autism spectrum disorders following in utero exposure to antiepileptic drugs. Neurology. 2008;71(23):1923–4.
4. Cummings C, Stewart M, Stevenson M, et al. Neurodevelopment of children exposed in utero to lamotrigine, sodium valproate and carbamazepine. Arch Dis Child. 2011 Jul;96(7):643–7. DOI: 10.1136/adc.2009. 176990. Epub 2011 Mar 17.
5. Meador KJ, Penovich P, Baker GA, et al. NEAD Study Group. Antiepileptic drug use in women of childbearing age. Epilepsy Behav. 2009 Jul;15(3):339–43. DOI: 10.1016/j.yebeh.2009.04.026. Epub 2009 May 27.
6. Thomas SV, Sukumaran S, Lukose N, et al. Intellectual and language functions in children of mothers with epilepsy. Epilepsia. 2007 Dec;48(12): 2234–40. Epub 2007 Oct 15.
7. Meador KJ, Baker GA, Browning N, et al. NEAD Study Group. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013;12(3):244–52. DOI: 10.1016/S1474-4422(12)70323-X. Epub 2013 Jan 23.
8. Карлов ВА, Жидкова ИА, Серкина АВ, Кожокару АБ. Интеллектуальное, психомоторное и речевое развитие детей, рожденных от страдающих эпилепсией матерей. Журнал неврологии и психиатрии им. С.С. Корсакова. Эпилепсия. 2010; (3): 25–30. [Karlov WA, Zhidkova IA, Serkina AV, Kozhokar AB. Intellectual, psychomotor and speech development of the children born from mothers having epilepsy. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. Epilepsiya. 2010;(3):25–30]. (In Russ.)].
9. Christensen J, Grоnborg TK, Sоrensen MJ, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013 Apr 24;309(16):1696–703. DOI: 10.1001/jama.2013.2270.
10. Cohen MJ, Meador KJ, Browning N, et al. Fetal antiepileptic drug exposure: motor, adaptive and emotional/behavioural Functioning at age 3 years. Epilepsy Behav. 2011 Oct;22(2):240–6. DOI: 10.1016/j.yebeh.2011.06.014. Epub 2011 Jul 23.
11. Cohen MJ, Meador KJ, Browning N, et al. NEAD study group. Fetal antiepileptic drug exposure: Adaptive and emotional/behavioral functioning at age 6 years. Epilepsy Behav. 2013 Nov;29(2):308–15. DOI: 10.1016/j.yebeh.2013.08.001. Epub 2013 Sep 5.
12. Власов ПН. Синдром поликистозных яичников при эпилепсии – ятрогенная проблема? Фарматека. 2005;17:57–60. [Vlasov PN. A syndrome of polycystous ovaries at epilepsy – a yatrogenny problem? Farmateka. 2005;17:57–60.(In Russ.)].
13. Жидкова ИА, Карлов ВА, Кунькина ЮБ. и др. Репродуктивный потенциал женщин, страдающих эпилепсией. Журнал неврологии и психиатрии им. С.С. Корсакова. 2009;109(11):31–6. [Zhidkova IA, Karlov WA, Kunkina YuB, et al. Reproductive potential of the women having epilepsy. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2009;109(11):31–6. (In Russ.)].
14. Goldberg-Stern H, Yaacobi E, Phillip M, de Vries L. Endocrine effects of valproic acid therapy in girls with epilepsy: A prospective study. Eur J Paediatr Neurol. 2014 Nov;18(6):759–65. DOI: 10.1016/j.ejpn. 2014.07.004. Epub 2014 Jul 29.
15. Recommendation of the Pharmacovigilance Risk Assessment Committee pursuant to Article 31 of Directive 2001/83/EC resulting from pharmacovigilance data, for valproate and related substances-containing medicinal products EMA/PRAC/548192/2014
16. FDA.gov
17. Карлов ВА. Эпилепсия у детей и взрослых, женщин и мужчин. Москва: Медицина; 2010. 720 с. [Karlov WA. Epilepsiya u detey i vzroslykh, zhenshchin i muzhchin. [Epilepsy at children and adults, women and men]. Moscow: Meditsina; 2010. 720 p.].
18. Glauser T, Ben-Menachem E, Bourgeois B, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013 Mar;54(3):551–63. DOI: 10.1111/epi.12074. Epub 2013 Jan 25.
19. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. London: Royal College of Physicians (UK). Issued: January 2012 last modified: December 2013. NICE clinical guideline 137.
20. Morrow J, Russell A, Guthrie E, et al. Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy register. J Neurol Neurosurg Psychiatry. 2006 Feb;77(2):193–8. Epub 2005 Sep 12.
21. Карлов ВА, Власов ПН, Петрухин ВА, Краснопольский ВИ. Особенности терапии эпилепсии во время беременности. Методические рекомендации МЗ РФ. 2001 г. N130. Москва; 2001:1–15. [Karlov VA, Vlasov PN, Petrukhin VA, Krasnopol'skiy VI. Osobennosti terapii epilepsii vo vremya beremennosti. Metodicheskie rekomendatsii MZ RF. [Features of therapy of epilepsy during pregnancy. Methodical recommendations of Ministry of Health Russian Federation. 2001;N130]. Moscow; 2001:1–15].
22. Harden CL, Hopp J, Ting TY, et al. Management issues for women with epilepsy – Focus on pregnancy (an evidence-based review): I. 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 the American Epilepsy Society. Epilepsia. 2009 May;50(5):1229–36. DOI: 10.1111/j.1528-1167.2009.02128.x.
23. Власов ПН, Карлов ВА, Петрухин ВА. Эпилепсия и беременность: современная терапевтическая тактика. Неврология, нейропсихиатрия, психосоматика. 2013;(1):13–17. [Vlasov PN, Karlov VA, Petrukhin VA. Epilepsy and pregnancy: current therapeutic tactics. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(1):13–17. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-27112013-2391
24. Приказ МЗ и СР РФ от 5 декабря 2007 г. No 736. [Prikaz MZ i SR RF ot 5 dekabrya 2007 g. No 736. [The order Ministry of Health and Social Development Russian Federation of December 5, 2007 No. 736]. (In Russ.).
25. Harden CL, Meador KJ, Pennell PB, et al. Management issues for women with epilepsy – Focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009 May;50:1237–46.
26. St Louis EK, Gidal BE, Henry TR, et al. Conversions between monotherapies in epilepsy: Expert consensus. Epilepsy Behav. 2007 Sep;11(2):222–34. Epub 2007 Jun 22.
27. Harden CL, Pennell PB, Koppel BS, et al. Management issues for women with epilepsy – Focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009 May;50:1247–55.
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For citations:
Vlasov P.N. Use of valproates in women of childbearing age and pregnant women with epilepsy. Neurology, Neuropsychiatry, Psychosomatics. 2015;7(1S):4-9. (In Russ.) https://doi.org/10.14412/2074-2711-2015-1S-4-9
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