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Epilepsy and Pregnancy

Published online by Cambridge University Press:  18 September 2015

Joseph Bruni
Affiliation:
Neurology Service, Veterans Administration Hospital and Department of Neurology, University of Florida College of Medicine, Gainesville, Florida
L. James Willmore*
Affiliation:
Neurology Service, Veterans Administration Hospital and Department of Neurology, University of Florida College of Medicine, Gainesville, Florida
*
Neurology Service (127), Veterans Administration Hospital, Gainesville, Florida 32602 U.S.A.
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The management of the pregnant epileptic requires close cooperation between the neurologist and obstetrician. To prevent complications, knowledge is required about the natural history of epilepsy during pregnancy, the possible teratogenic effects of antiepileptic drugs, and changes in their absorption, biotransformation, and excretion. Close plasma antiepileptic drug monitoring is required because of the change in the handling of antiepileptic drugs during pregnancy. The treatment of status epilepticus with intravenous phenytoin is effective. Drug interactions which may lead to toxic plasma levels of some drugs and subtherapeutic plasma levels of others should be anticipated. The risk of problems resulting from antiepileptic drug therapy during pregnancy appears to be minor, provided that proper medical supervision is available. Newer antiepileptic drugs should not be administered to the pregnant epileptic until their safety in pregnancy is fully established.

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 1979

References

Alagille, D., Odievre, M., Houlle-Mare, L., et al. (1968). Avitaminose K neonatale severe chez 2 enfants nes de mere traitre par des anticomitiaux. Arch. Franc. Pediatr. 25:3141.Google Scholar
Backstrom, T. (1976). Epilepsy in women. Estrogen and progesterone plasma levels. Experientia 32:248249.CrossRefGoogle ScholarPubMed
Baptisti, T. JR. (1938). Epilepsy and pregnancy. Am. J. Obstet. Gynecol. 35:818824.CrossRefGoogle Scholar
Bjerkedal, T., Bahna, S.L. (1973). The course and outcome of pregnancy in women with epilepsy. Acta Obstet. Gynecol. Scand. 52:245248.CrossRefGoogle ScholarPubMed
Bruni, J., Wilder, B.J. (1979). Toxicology of antiepileptic drugs. In: Handbook of Clinical Neurology, Intoxications of the Nervous System 2. Vinken, P.J. and Bruyn, G.W., Eds., Amsterdam, North Holland Publishing Company, in press.Google Scholar
Burnet, C.W.F. (1946). A survey of the relation between epilepsy and pregnancy. J. Obstet. Gynaecol. Br. Commonw. 53:539556.CrossRefGoogle Scholar
Devi, P.K., Mehta, S.K., Manchanda, S. (1973). Vitamin B12 and folate status in normal puerperium. Indian J. Med. Res. 61:454460.Google ScholarPubMed
Devore, G.R., Woodbury, D.M. (1977). Phenytoin: an evaluation of several teratogenic mechanisms. Epilepsia. 18:387396.CrossRefGoogle ScholarPubMed
DILANTIN MONOGRAPH. Clinical Research Series, February 6, 1973. Ann Arbor, MI.Parke-Davis and Company.Google Scholar
Dimsdale, H. (1959). The epileptic in relation to pregnancy. Br. Med. J. 11:11471150.CrossRefGoogle Scholar
Douglas, H. (1966). Hemorrhage in the newborn. Lancet. 1:816817.CrossRefGoogle Scholar
Fedrick, J. (1973). Epilepsy and pregnancy: A report from the Oxford Record Linkage Survey. Br. Med. J. 2:442448.CrossRefGoogle Scholar
Gabler, W.L., Hubbard, G.L. (1973a). Metabolism in vitro of 5,5-diphenylhydan-toin. Biochem. Pharmacol. 21:30713073.Google Scholar
Gabler, W.L., Hubbard, G.L. (1973b). The metabolism of 5,5-diphenylhydantoin in nonpregnant and pregnant rhesus monkeys. Arch. Int. Pharmacodyn. Ther. 203:7295.Google Scholar
Gibbs, F.A., Reid, D.A. (1942). The electroencephalogram in pregnancy. Am. J. Obstet. Gynecol. 44:672675.CrossRefGoogle Scholar
Glazko, A.J. (1973). Diphenylhydantoin metabolism — a prospective review. Drug. Metab. Dispos. 1:711713.Google ScholarPubMed
Glazko, A.J., Chang, T., Baukema, J., et al. (1969). Metabolic disposition of diphenylhydantoin in normal human subjects following IV administration. Clin. Pharmacol. Ther. 10:498504.CrossRefGoogle Scholar
Goodwin, J.F., Lawson, C.W. (1947). Status epilepticus complicating pregnancy. Br. Med. J. 1:332333.CrossRefGoogle Scholar
Grosse, K.P., Schwanitz, G., Rott, H.D., et al. (1972). Chromosomenunter suchunger bei Behaldlung mit Anticonvulsiva. Humangenetik. 16:209216.Google Scholar
Guarino, A.M., Gram, T.E., Schroeder, D.H., et al. (1969). Alterations in kinetic constants for hepatic microsomal aniline hydroxylase and ethylmorphine N-demethylase associated with pregnancy in rat. J. Pharmacol. Exp. Ther. 168:224228.Google Scholar
Higgins, T.A., Comerford, J.B. (1974). Epilepsy in pregnancy. J. Irish Med. Ass. 67:317320.Google ScholarPubMed
Hill, D. (1963). Epilepsy: clinical aspects. In: Electroencephalography. Hill, D. and Parr, G., Eds., New York; MacMillan, pp 250294.Google Scholar
Janz, D. (1975). Teratogenic risks of antieplileptic drugs. Epilepsia. 16:159169.CrossRefGoogle Scholar
Klein, M.D., Goodfriend, M.J., Shey, I.A. (1956). Status epilepticus and pregnancy. Am. J. Obstet. Gynecol. 72:188190.CrossRefGoogle ScholarPubMed
Knight, A.H., Rhind, E.G. (1975). Epilepsy and pregnancy: A study of 153 pregnancies in 59 patients. Epilepsia. 16:99110.CrossRefGoogle ScholarPubMed
Lander, C.M., Edwards, V.E., Eadie, M.J., et al. (1977). Plasma anticonvulsant concentrations during pregnancy. Neurology. 27:128131.CrossRefGoogle ScholarPubMed
Logothesis, J., Harner, R., Morrel, F., et al. (1959). The role of estrogens in catamenial exacerbation of epilepsy. Neurology 9:352360.CrossRefGoogle Scholar
Lowe, C.R. (1973). Congenital malformations among infants born to epileptic mothers. Obstet. Gynecol. Survey. 28:492494.CrossRefGoogle Scholar
Marcus, E.M., Watson, C.W., Goldman, P.L. (1966). Effects of steroids on cerebral electrical activity. Arch. Neurol. 15:521532.CrossRefGoogle ScholarPubMed
Mauguiere, F., Quoex, C., Bello, S. (1975). Epileptogenic properties of folic acid and N5-methyltetrahydrofolate in cat. Epilepsia. 16:535541.CrossRefGoogle ScholarPubMed
McWilliam, P.K.A., Leeds, M.B. (1958). IV phenytoin sodium in continuous convulsions in children. Lancet. 2:11471149.CrossRefGoogle Scholar
Metrakos, K., Metrakos, J.D. (1961). Genetics of convulsive disorders. II. Genetic and electroencephalographic studies in centrencephalic epilepsy. Neurology. 11:474483.CrossRefGoogle ScholarPubMed
Mirkin, B.L. (1971). Diphenylhydantoin: Placental transport, fetal localization, neonatal metabolism, and possible teratogenic effects. J. Pediatr. 78:329337.CrossRefGoogle ScholarPubMed
Mountain, K.R., Hirsh, J., Gallus, A.S. (1970). Neonatal coagulation defect due to anticonvulsant drug treatment in pregnancy. Lancet. 1:265268.CrossRefGoogle ScholarPubMed
Mygind, K.I., Darn, M., Christiansen, J. (1974). Phenytoin and phenobarbital plasma clearance during pregnancy. Acta Neurol. Scand. 54:160166.CrossRefGoogle Scholar
Perlman, M. (1967). Placental transfer of phenobarbital. Lancet. 2:987.CrossRefGoogle Scholar
Peterson, D.I., Zweig, R.W. (1974). Absorption of anticonvulsants after jejunoileal bypass. Bull. Los Angeles Neurol. Soc. 39:5155.Google ScholarPubMed
Ramsay, R.E., Strauss, R.G., Wilder, B.J., et al. (1978). Status epilepticus in pregnancy: Effect of phenytoin malabsorption on seizure control. Neurology. 28:8589.CrossRefGoogle ScholarPubMed
Ramsay, R.E., Strauss, R.G., Wilder, B.J., et al. (1979). Phenytoin kinetics and seizure frequency during pregnancy. Excerpta Medica. In press.Google Scholar
Rane, A., Engin, M.G., Borga, O., et al. (1974). Plasma disappearance of transpla-centally transferred diphenylhydantoin in the newborn studied by mass fragmen-tography. Clin. Pharmacol. Ther. 15:3945.CrossRefGoogle Scholar
Reynolds, E.H. (1973). Anticonvulsants, folic acid and epilepsy. Lancet. 1:13761378.CrossRefGoogle ScholarPubMed
Sabin, M., Oxorn, H. (1956). Epilepsy and pregnancy. Obstet. Gynecol. 17:175179.Google Scholar
Smith, D.B., Racusen, L.C. (1973). Folate metabolism and anticonvulsant efficacy of phenobarbital. Arch. Neurol. 28:1822.CrossRefGoogle ScholarPubMed
Solomon, G.E., Hilgartner, M.W., Kutt, H. (1972). Coagulation defects caused by diphenylhydantoin. Neurology. 22:11651171.CrossRefGoogle ScholarPubMed
Solomon, G.E., Hilgartner, M.W., Kutt, H. (1974). Phenobarbital induced coagulation defects in cats. Neurology. 24:920924.CrossRefGoogle ScholarPubMed
Spiedel, B.D., Meadow, S.R. (1972). Maternal epilepsy and abnormalities of the fetus and newborn. Lancet. 2:839843.CrossRefGoogle Scholar
Suter, C., Klingman, W.O. (1957). Seizure states and pregnancy. Neurology. 7:105118.CrossRefGoogle Scholar
Timiras, P.S. (1969). Role of hormones in development of seizures. In: Basic Mechanisms of the Epilepsies. Jasper, H.M., Ward, A.A. Jr., and Pope, A., Eds., Boston; Little, Brown and Company, pp 727736.Google Scholar
Van Crevald, S. (1958). Nouveaux aspects de la maladie hemorrhagique du nouveaune. Arch. Franc. Pediat. 15:721735.Google Scholar
Waddell, W.J., Mirkin, B.L. (1972). Distribution and metabolism of diphenylhydantoin l4C in fetal and maternal tissues of the pregnant mouse. Biochem. Pharmacol. 21:547552.CrossRefGoogle Scholar
Wallis, W., Kutt, H., McDowell, F. (1968). IV DPH in treatment of acute repetitive seizures. Neurology. 18:513525.CrossRefGoogle Scholar
Wilder, B.J., Ramsay, R.E., Willmore, L.J., et al. (1977). Efficacy of intravenous phenytoin in the treatment of status epilepticus. Kinetics of central nervous system penetration. Ann. Neurol. 1:511518.CrossRefGoogle ScholarPubMed
Wooley, P.E., Timiras, P.S. (1962a). Estrous and circadian periodicity and electroshock convulsions in rats. Am. J. Physiol. 202:379382.CrossRefGoogle Scholar
Wolley, D.E., Timiras, P.S. (1962b). The gonad-brain relationship: Effects of female sex hormones on electroshock convulsions in the rat. Endocrinology. 70:196209.CrossRefGoogle Scholar
Woodbury, D.M., Kemp, J.M. (1971). Pharmacology and mechanism of action of diphenylhydantoin. Psychiatr. Neurol. Neurochir. 74:91115.Google ScholarPubMed