Mahmut ÖNCÜL, Seyfettin ULUDAĞ, Vildan OCAK, Esat EŞKAZAN, Mustafa ALBAYRAK, Rıza MADAZLI

6924

Gebelik ve epilepsi: 44 olgunun değerlendirilmesi

Epilepsi migrenden sonra gebelikte en sık karşılaşılan nörolojik hastalıktır. Çalışmamızda Cerrahpaşa tıp fakültesi kadın hastalıkları ve doğum anabilim dalında gebelik takipleri yapılan 44 epilepsi ve gebelik olgusu irdelendi. Olguların ortalama doğum haftası 39±0.7 hafta, ortalama doğum kilosu 3291±474 gram olarak saptandı. İntrauterin gelişme geriliğine rastlanmadı. Gebelerin ortalama epilepsi süresi 11.7± 9 yıl, epilepsi tipi %79.6’sında (35/44) grand mal, %4.5’inde (2/44) petit mal ve %15.9’unda (7/44) parsiyel epilepsi olarak belirlendi. Çalışma grubunu oluşturan 44 gebelik ve epilepsi olgusunun 24’ünün (%54.5) takipleri sırasında epileptik atak geçirdikleri gözlendi. Epileptik atakların en sık ilk 12 hafta içerisinde ve AEİ tedavisini kesen gebelerde geliştiği saptandı. Gebe kalmadan önceki 6 ay içerisinde veya gebe kaldığını anlayınca kullandığı AEİ tedavisini kesen 11 olgunun 9’unun (81.8) gebeliklerinde epileptik atak geçirdiği belirlendi. Epileptik gebelerin 22’sinin (%50) gebe kalmadan önce danışma aldığı saptandı. Epilepsi ve gebelik olgularının takibinde ana hedef mümkün olan en düşük ilaç miktarı ile epileptik atakların iyi kontrolüdür. Uygun yaklaşım ve takip ile hemen hemen genel popülasyona benzer olumlu sonuçlar elde etmek mümkün olabilmektedir.

Pregnancy and epilepsy: Evaluation of 44 patients.

Background and Design.- Epilepsy is the most frequent neurologocical disorder after migraine during pregnancy. In this report, we aimed to determine the situation of epilepsy and pregnancy patients and share our clinical experiences in our country that prepregnancy consultation is insufficient.44 epilepsy and pregnancy patients, whose gestational surveys were made at Cerrahpaşa Faculty of Medicine Department of Obstetric and Gynecology, were involved. The cases were evaluated by demographic characteristics like age, parity, gravida as well as how many years they had epilepsy, the last time of their seizure and the epileptic drugs they used before pregnancy.Results.- The mean delivery week was 39±0.7 weeks, and birth weight was 3291±474g. The mean epilepsy period was 11.7±9 years and epilepsy type was grand mal in 79.6%, petit mal in 4.5%, partial epilepsy in 15.9%. It was found that 24 of the 44 (54.5%) epilepsy and pregnancy patient had seizure during their follow-up. The seizures were more often seen during first 12 weeks and the patients that stopped taking antiepileptic drug treatment. 9 of the 11 patients (81.8%) that discontinued receiving drugs had an epileptic seizure. It was seen that only 22 epileptic pregnant patient had prepregnancy consultation.Conclusion.- The major goal in the follow-up of pregnancy and epilepsy patients should be taking seizures under control with minimum drugs. It can be possible to obtain good outcome almost like general population with appropriate approach and follow-up strategies.
PDF

___

  • 1. Richmond JR, Krishnamoorthy P, Andermann E, Benjamin A. Epilepsy and pregnancy : An obstetric perspective. Am J Obstet and Gynecol 2004; 190: 371
  • 2. Dravet C, Julian C, Legras C, et al. Epilepsy, antiepileptic drugs, and malformations in children of women with epilepsy: a French prospective cohort study. Neurology. 1992; 42(4 suppl 5): S75-S82.
  • 3. Samrén EB, van Duijn CM, Christiaens GC, et al. Antiepileptic drug regimens and major congenital abnormalities in the offspring. Ann Neurol. 1999; 46: 739-746.
  • 4. Crawford P. CPD Education and self-assessment. Epilepsy and pregnancy. Seizure. 2001; 10: 212-219.
  • 5. Morrell MJ. Reproductive and metabolic disorders in women with epilepsy. Epilepsia. 2003; 44 (Sup 4): 11-20.
  • 6. Gaily E, Kantola-Sorsa E, Granstrom ML. Intelligence of children of epileptic mothers. J Pediatr. 1988; 113: 677-684.
  • 7. Wide K, Winbladh B, Tomson T, et al. Psychomotor development and minor anomalies in children exposed to antiepileptic drugs in utero: a prospective population-based study. Dev Med Child Neurol. 2000; 42: 87-92.
  • 8. Steegers-Theunissen RP, Renier WO, Borm GF, et al. Factors influencing the risk of abnormal pregnancy outcome in epileptic women: a multicentre prospective study. Epilepsy Res. 1994; 18: 261-269.
  • 9. Holmes LB, Harvey EA, Coull BA, et al. The teratogenicity of anticonvulsant drugs. N Engl J Med. 2001; 344: 1132-1138.
  • 10. Karceski S, Morrell M, Carpenter D. The expert consensus guidelines series: treatment of epilepsy. Epilepsy Behav. 2001; 2: 1-50.
  • 11. Mawer G, Clayton-Smith J, Coyle H, et al. Outcome of pregnancy in women attending an outpatient epilepsy clinic: adverse features associated with higher doses of sodium valproate. Seizure. 2002; 11: 512-518.
  • 12. Sabers A, aRogvi-Hansen B, Dam M, et al. Pregnancy and epilepsy: a retrospective study of 151 pregnancies. Acta Neurol Scand. 1998; 97: 164-170.
  • 13. Morrell MJ. Epilepsy in women: the science of why it is special. Neurology. 1999; 53(4 suppl 1): S42-S48.
  • 14. Delgado-Escueta AV, Janz D. Consensus guidelines: Preconception counseling, management, and care of the pregnant woman with epilepsy. Neurology 1992; 42: 149-155
  • 15. Anonymous From the Centers for Disease Control and Prevention. Recommendations for use of folic acid to reduce number of spina bifida cases and other neural tube defects. JAMA 1993; 269: 1233-8.
  • 16. Bardy AH. Incidence of seizures during pregnancy, labor and puerperium in epileptic women: a prospective study. Acta Neurol Scand. 1987; 75: 356-360.
Cerrahpaşa Tıp Dergisi-Cover
  • ISSN: 1300-5227
  • Başlangıç: 1998
  • Yayıncı: -
Arşiv
Sayıdaki Diğer Makaleler

Derin boyun enfeksiyonu: Bir olgu sunumu

Erdoğan GÜLTEKİN, Mehmet KÜLEKÇİ, Ömer Necati DEVELİOĞLU, Kürşat YELKEN

Gecikmiş arteryel emboliler: Embolektomi yapılmalı mıdır?

Erkan İRİZ, Volkan SİNCİ, Sedat KALAYCIOĞLU

Cerrahpaşa Tıp Fakültesi, aile hekimliği polikliniğine başvuran hastaların 3 yıllık profili

Necdet SÜT, Turfaner Nurver ERTÜRK, Fikret SİPAHİOĞLU

Gebelik ve epilepsi: 44 olgunun değerlendirilmesi

Mahmut ÖNCÜL, Seyfettin ULUDAĞ, Vildan OCAK, Esat EŞKAZAN, Mustafa ALBAYRAK, Rıza MADAZLI

Akut puromycine aminonucleoside nefrozda proteinüri, kreatinin klirensi, serum albumin değerleri ile böbrek cisimciğindeki ultrastrüktürel değişiklikler ve slit-pore sayısı arasındaki ilişkiler

Güngör ŞATIROĞLU, Sibel KÖKTÜRK, Mümin UZUNALAN, Hüseyin SÖNMEZ, Meltem PEKPAK, İsmail SEÇKİN, Bülent URULUER, Zeynep ÖZTÜRK

Dev üretra taşı: Bir olgu sunumu

Ramazan ALTINTAŞ, Hakan SUİÇMEZ, Oktay DEMİRKESEN, Özgür SANCAKLI, Cabir ALAN