Management of epilepsy during pregnancy with antiepileptic drugs at the lowest effective dose to reduce the fetal risk ; three cases

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  • 胎児リスクを低減するために必要最小限の抗てんかん薬量での管理を試みたてんかん合併妊娠3症例
  • 症例報告 胎児リスクを低減するために必要最小限の抗てんかん薬量での管理を試みたてんかん合併妊娠3症例
  • ショウレイ ホウコク タイジ リスク オ テイゲン スル タメニ ヒツヨウ サイショウゲン ノ コウテンカンヤクリョウ デ ノ カンリ オ ココロミタ テンカン ガッペイ ニンシン 3 ショウレイ

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Abstract

Because antiepileptic drugs (AEDs) have a long-term influence on intelligence and behavior as well as teratogenicity for the fetus, AEDs with a lower risk to the fetus should be used at the lowest effective dose possible. The optimal dose based on the clinical course should be set before pregnancy to minimize the risk to the mother and child. However, the pregnancy of a woman with epilepsy (WWE) is not always planned. We encountered three patients with idiopathic generalized epilepsy, who became pregnant before the optimal regimen had been set. To minimize the risks to the fetus and mother, we adjusted the AED prescription mainly based on the course of seizure control. In two cases, we were able to reduce the fetal risk of the AEDs by switching from multiple drug treatment (MDT) to monotherapy or by reducing the dose of more teratogenic AEDs under MDT. In both cases, the perinatal outcomes of the mother and neonate were favorable. In the third case, seizures occurred due to insufficient treatment associated with excessive reduction of the AED dose and poor compliance of the patient with the prescription of AED. To achieve optimal obstetric and neonatal outcomes, adjustment of the AED prescription after conception should be made under closer cooperation between obstetricians and neurologists, while providing accurate information and counseling for the WWE and her family. [Adv Obstet Gynecol, 65(3) : 261-267, 2013 (H25.8)]

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