Gebelerde Epilepsi Tedavisi

Epilepsi provake edilmeyen nöbetlerin tekrarlamasıyla oluşan bir beyin hastalığıdır. Epilepsi dünya popülasyonunun%2’sini etkilemektedir. Epilepsili hastaların büyük bir kısmı üreme çağındaki kadınlardır. Epilepsi tanılı hastaların,gebelik sürecinde yönetimi zordur. Yüksek oranda sağlıklı (%92-96) çocuk doğurmalarına rağmen, prematür doğum,düşük doğum ağırlığı, fetal ve neonatal ölüm riski, konjenital malformasyonlar ve gelişme geriliği oranları normalpopülasyona göre artış göstermektedir. Genel popülasyona göre kongenital malformasyonu olan çocuk doğurma oranıepilepsi tanılı gebelerde 2-5 kat daha fazladır. Nöbetlerin kendisi ve kullanılan antiepileptik ilaçlar fetüsün sağlığınıolumsuz yönde etkileyebilir. Gebelikteki nöbet sayısı arttıkça, gebelik sonuçları olumsuz olarak etkilenmektedir. Birçokçalışma antiepileptik ilaçlara doğum öncesi maruz kalma ile hem fiziksel anomaliler hem de nöro gelişimsel bozulmariski arasında bir ilişki olduğunu göstermektedir. Bu nedenlerle takip ve tedavide temel amaç; hastanın nöbet tipineuygun, en düşük dozda ilaç tedavisi altında, maksimum nöbet kontrolünün sağlanarak sağlıklı bir gebelik sürecininsürdürülmesi ile sağlıklı bir bebeğin doğumunun sağlanması olmalıdır.

Epilepsy Treatment in Pregnant Women

Epilepsy is a brain condition characterized by the recurrence of unprovoked seizures. Epilepsy affects 2% of the world population. The majority of patients with epilepsy are women of reproductive age. Management of epileptic patient during pregnancy can be difficult. Even though they give birth to healthy children most of the times (92-96%), premature birth, low birth weight, fetal and neonatal death, congenital malformations and growth retardation rate are higher in epileptic patients than normal population. Congenital malformations are 2–5 times more prevalent in children of epileptic women in comparison with the general population. Seizures and antiepileptic drugs can have a negative effect on fetus health. As the number of seizures increases in pregnancy, pregnancy outcomes are adversely affected. Many studies have shown an association between prenatal exposure to antiepileptic drugs and increased risk of both physical anomalies and neurodevelopmental impairment. For these reasons the main purpose of management of epileptic patient during pregnancy is to choose the most appropriate antiepileptic medication with lowest effective dose for the patient to gain maximum seizure control and to maintain a healthy pregnancy period with the birth of a healthy baby.

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