Epilepsy & behavior : E&B · 2025
Balancing foetal disadvantage and seizure freedom in women capable of pregnancy - the Australian pregnancy register experience.
СтатьяНазвание и аннотация: Перевод в очереди
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Vajda Frank, O'Brien Terence J, Graham Janet, Hitchcock Alison, Perucca Piero, Lander Cecilie, Eadie Mervyn
Аннотация
OBJECTIVE: To determine which antiseizure medications (ASMs) provide the best overall compromise between a lower risk of foetal malformation and continuing control of maternal epilepsy during pregnancy.
METHODS: Analysis of relevant data on women taking one of the 5 most commonly prescribed ASMs (levetiracetam (LEV), lamotrigine (LTG), carbamazepine (CBZ). Topiramate (TPM) and valproate (VPA)) in 2403 pregnancies of women with epilepsy (WWE) contained in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs (APR).
RESULTS: LEV offered the greatest advantage with regard to low risk of foetal malformation, followed by LTG, then CBZ and then VPA. In relation to preserving seizure freedom throughout pregnancy valproate (VPA) was best, followed by LEV and CBZ, then LTG. When these individual rankings, equally weighted, were combined, LEV scored highest, followed by VPA and then LTG and CBZ (equal). However, if avoiding foetal malformation was weighted more heavily, the sequence became LEV, then LTG and CBZ, and then VPA. TPM rated poorly to all criteria assessed.
SIGNIFICANCE: Overall, LEV appeared the most advantageous ASM to employ in the population studied, balancing the risk of foetal malformations with the chance of maintaining seizure control. This outcome is broadly in conformity with prescriber behaviour determined largely by trial-and-error experience in contemporary Australian practice.
METHODS: Analysis of relevant data on women taking one of the 5 most commonly prescribed ASMs (levetiracetam (LEV), lamotrigine (LTG), carbamazepine (CBZ). Topiramate (TPM) and valproate (VPA)) in 2403 pregnancies of women with epilepsy (WWE) contained in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs (APR).
RESULTS: LEV offered the greatest advantage with regard to low risk of foetal malformation, followed by LTG, then CBZ and then VPA. In relation to preserving seizure freedom throughout pregnancy valproate (VPA) was best, followed by LEV and CBZ, then LTG. When these individual rankings, equally weighted, were combined, LEV scored highest, followed by VPA and then LTG and CBZ (equal). However, if avoiding foetal malformation was weighted more heavily, the sequence became LEV, then LTG and CBZ, and then VPA. TPM rated poorly to all criteria assessed.
SIGNIFICANCE: Overall, LEV appeared the most advantageous ASM to employ in the population studied, balancing the risk of foetal malformations with the chance of maintaining seizure control. This outcome is broadly in conformity with prescriber behaviour determined largely by trial-and-error experience in contemporary Australian practice.