Epilepsy in Women E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 400

Veröffentlichungsjahr: 2013

Beschreibung

Epilepsy requires careful management and monitoring through a woman’s life

Epilepsy is a complex disease. The hormonal changes women experience, both day-to-day menstrual fluctuations and the longer waxes and wanings of a reproductive lifetime, make the management of epilepsy even more complicated. At some point, the well-being of a second person, a fetus, might also have to be taken into account.

Epilepsy in Women provides a detailed guide to this challenge. The wide-ranging approach encompasses all aspects of a woman’s life including:

• Social and psychological impacts
• The impact in reproductive life
• Contraception
• Pregnancy
• Fetal health and long term developmental outcomes
• Lactation
• Menopause

Each practical chapter begins and ends with a case study that demonstrates the more general challenge. The authors develop themes to provide clinical guidance based on evidence and experience.

Written and edited by an international cast of experts, Epilepsy in Women provides crucial tips and recommendations for neurologists and gynecologists who need to be aware of the subtle effects of epilepsy on woman’s life.

Leseprobe

Contents

Preface

Contributors

CHAPTER 1: Gender Difference in Epidemiology and Comorbidities of Epilepsy

Background and important detail

Incidence of epilepsy

Prevalence of epilepsy

Epilepsy syndromes and comorbidity

Attitudes toward epilepsy and gender

Prognosis and mortality of epilepsy

Use of antiepileptic drugs

Implications for management

CHAPTER 2: The Social and Psychological Impacts of Epilepsy

Determinants of the social and psychological impacts of epilepsy

Epilepsy in the female child

The adolescent female with epilepsy

The adult female with epilepsy

The elderly female with epilepsy

CHAPTER 3: Neurosteroid Influences on Neuronal Excitability: The Menstrual Cycle and Catamenial Epilepsy as Dynamic Models

Introduction

The menstrual cycle

Catamenial epilepsy

Neuroendocrine aspects of catamenial epilepsy

Potential mechanisms of catamenial seizures

Progesterone therapy for catamenial epilepsy

Novel treatments for catamenial epilepsy

Conclusions

Acknowledgments

CHAPTER 4: Catamenial Epilepsy

Introduction to the field

Background and important details

Treatment

CHAPTER 5: Impact of Epilepsy and AEDs on Reproductive Health

Background and important details

Menstrual disorders

Polycystic ovary syndrome

Effect of epilepsy on hypothalamo-pituitary axis

Effect of AEDs on endogenous hormones

Implications for management

CHAPTER 6: Contraception and Epilepsy

Background and important detail

Hormonal contraceptive methods

Pharmacokinetic interactions between contraceptive hormones and AEDs

Hormonal contraception and seizure control

Intrauterine contraception

Dual benefit of pregnancy prevention and decreased menstrual bleeding

Implications for management

CHAPTER 7: Diagnostic Challenges with Seizures in Pregnancy

Seizures in pregnancy

Eclampsia

Posterior reversible encephalopathy syndrome

Reversible cerebral vasoconstriction syndrome

Stroke during pregnancy

Postpartum cerebral angiopathy

Amniotic fluid embolism

Central nervous system infections

Autoimmune encephalitis

Brain tumors

Diagnostic approach

CHAPTER 8: Seizure Control During Pregnancy

Background and details

Seizure control in pregnancy

Alterations in seizure control in different stages of pregnancy, labor, and delivery

Risk factors for deteriorated seizure control

Measures to reduce the risk of seizures during pregnancy

Implications for management

The role of pre-conception counseling and patient education

CHAPTER 9: Effect of Pregnancy on AED Kinetics

Introduction

Implications of AED pharmacokinetics before pregnancy

Pharmacokinetic changes during pregnancy

Implications of AED pharmacokinetics after birth

Implications for management

CHAPTER 10: Fetal and Maternal Risks with Seizures

General effects of seizures

Seizures and fetal malformations

Seizures and spontaneous abortions

Seizures and common obstetric complications

Seizures and maternal deaths

Seizures and stillbirths

Seizures and childbirth (i.e., labor, delivery and early puerperium)

Late child effects of maternal seizures during pregnancy

Implications for management

CHAPTER 11: Obstetrical Outcome and Complications of Pregnancy

Introduction

Pre-conception dialogue

Folate use

Complications of pregnancy

Delivery

Obstetrical outcome

Implications for management

CHAPTER 12: Mechanisms of Teratogenic Effects of AEDs

Background and important detail

Epoxidation

Oxidative stress

Altered folate metabolism

Histone deacetylases

Implications for management

CHAPTER 13: Major Congenital Malformations in Offspring of Women with Epilepsy

Introduction and background

Some methodological considerations

Major congenital malformations and AED exposure

Conclusions

CHAPTER 14: Fetal AED Syndromes

Background and important details

Implications for management

CHAPTER 15: Postnatal Cognitive Development

Background

Pregnancy outcomes with regard to neurodevelopment

Neurodevelopmental effects of individual AEDs

Breastfeeding and AEDs

Conclusions on cognitive outcomes from human studies

Implications for management

CHAPTER 16: Management of the Postpartum Period and Lactation

Breastfeeding: background and benefits

Women with epilepsy and breastfeeding

Safety issues

Depression

Contraception in the immediate postpartum period

Implications for management

CHAPTER 17: Management of Epilepsy and Pregnancy

Prior to planning pregnancy

During pregnancy

After delivery

CHAPTER 18: Perimenopause and Menopause

Background

Implications for management

CHAPTER 19: Bone Health

Background

Implications for management

Index

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Library of Congress Cataloging-in-Publication Data

Epilepsy in women / edited by Cynthia L. Harden, Sanjeev V. Thomas, Torbjörn Tomson.p. ; cm.Includes bibliographical references and index.

ISBN 978-0-470-67267-9 (hardback : alk. paper)I. Harden, Cynthia L. II. Thomas, Sanjeev V. III. Tomson, Torbjörn, 1950– [DNLM: 1. Epilepsy–etiology. 2. Epilepsy–physiopathology. 3. Menstruation–physiology. 4. Pregnancy Complications. 5. Sex Factors. 6. Women’s Health. WL 385]616.85′30082–dc23

2012037052

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: ©iStockphoto/billyfotoCover design by Meaden Creative

Preface

The science and practice of caring for women with epilepsy is constantly evolving and progressing. The relative teratogenic risks of specific antiepileptic drugs (AEDs), the nuances of monitoring AED levels during pregnancy and the capacity for epilepsy itself to be an endocrine disruptor are important findings that have changed practice, even as the field ­continues to be explored and refined. The editors present a comprehensive current snapshot of issues for women with epilepsy, couched around a clinical case relevant to each chapter which they hope will strike readers as both familiar and illuminating. While research is ongoing, this book comes at a time when some scientific milestones in the field have been reached. It can be confidently presented, for example, that multiple worldwide registries on pregnancy outcomes of women with epilepsy are ­consistent in their findings of implicating valproate as­having a dose-related risk for both structural and cognitive teratogenesiswith a risk above other AEDs. The complexity of contraceptive management is also now abundantly clear, and the expert recommendation is a simplified approach of avoiding hormonal contraceptives for women taking cytochrome P450 enzyme-inducing AEDs. With regard to the many unanswered questions in the field, this book aims to inform the reader about ongoing research avenues such as mechanisms of AED teratogenesis, reproductive hormonal neurophysiologic effects, and psychological risks for women with epilepsy, to cite several, in order to provide an update and a solid background to inform emerging clinical guidance. Linking epilepsy to other areas of ­neurology, with a recognition that neurologic illness cannot be as compartmentalized as perhaps we would like it to be, the editors have included an important clinical chapter discussing the differential diagnosis and ­evaluation for ­new-onset seizures during pregnancy.

It is intended that the joy and enthusiasm the editors have for the ­science of this field, for the wonderful patients we have had the privilege to care for, and for educating others are evident in this book. Our greatest emotion, however, is gratitude to the contributors, who have graciously shared their insight and expertise in chapters that are always enlightening and often downright poetic. The roster of contributors is an amazing group of international leaders distinguished by their scientific rigor combined with creativity, evident in the chapters written by each. The editors hope that the reader will enjoy each chapter and find them useful and thought-provoking, as well as discovering tenets that are ­timeless in an ever-­changing field.

Cynthia L. Harden Sanjeev V. ThomasTorbjörn Tomson

Contributors

Dina Battino MD Epilepsy Centre, Department of Neurophysiology and Experimental Epileptology IRCCS (Istituto di Ricovero a Cura a Carattere Scientifico) Neurological Institute “Carlo Besta” Foundation Milan, ItalyEttore Beghi MD Head of Laboratory of Neurological Disorders Istituto di Ricerche Farmacologiche “Mario Negri” Milano, ItalyMassimiliano Beghi MD Dipartimento di Salute Mentale Ospedale “G. Salvini” Garbagnate Milanese, ItalyIngrid Borthen MD, PhD Senior Consultant Head of the Obsterical Department Haukeland University Hospital Bergen, NorwayLynsey E. Bruce MS Dell Pediatric Research Institute Department of Nutritional Sciences University of Texas at Austin Austin, Texas USAAnne R. Davis MD, MPH Associate Professor of Clinical Obstetrics and Gynecology Department of Obstetrics and Gynecology Columbia University Medical Center New York, New York USARichard H. Finnell PhD Professor, Dell Pediatric Research Institute Departments of Nutritional Sciences, Chemistry and Biochemistry University of Texas at Austin; Director, Genomic Research Dell Children’s Medical Center Austin, Texas USAPeter B. Forgacs MD Rockefeller University New York, New York USAEvan R. Gedzelman MD Assistant Director of Clinical Neurophysiology Fellowship with Epilepsy Focus Assistant Professor of Neurology Emory University School of Medicine Department of Neurology Atlanta, Georgia USANils Erik Gilhus MD, PhD Professor of Neurology, Department of Clinical Medicine, University of Bergen Senior Consultant in Neurology Haukeland University Hospital Bergen, NorwayCynthia L. Harden MD Professor of Neurology Chief, Division of Epilepsy and Electroencephalography Hofstra North Shore-LIJ School of Medicine Cushing Neuroscience Institutes, Brain and Spine Specialists North Shore-Long Island Jewish Health System Great Neck, New York USAVilho K. Hiilesmaa MD, PhD Department of Obstetrics and Gynecology Helsinki University Central Hospital Helsinki, FinlandUsha Kini MBBS, MRCP, FRCP, MD Consultant Clinical Geneticist and Honorary Senior Lecturer University of Oxford Department of Clinical Genetics Oxford University Hospitals NHS Trust Oxford, UKAutumn M. Klein MD, PhD Chief, Division of Women’s Neurology Assistant Professor of Neurology and Obstetrics and Gynecology Departments of Neurology and Obstetrics and Gynecology UPMC Presbyterian/Magee Women’s Hospital of UPMC Pittsburgh, Pennsylvania USAGerhard Luef MD Associate Professor in Neurology Head of the Epilepsy Study Group Department of Neurology Medical University Innsbruck Innsbruck, AustriaKimford J. Meador MD Director of the Emory Epilepsy Center Professor of Neurology Emory University School of Medicine Department of Neurology Atlanta, Georgia USAKathleen M. Morrell MD Assistant Clinical Professor of Obstetrics and Gynecology Department of Obstetrics and Gynecology Columbia University Medical Center New York, New York USAAparna Nair PhD Assistant Professor Centre for Development Studies Trivandrum Kerala, IndiaAlison M. Pack MD, MPH Associate Professor of Clinical Neurology Department of Neurology Neurological Institute of New York Columbia University Medical Center New York, New York USAAna M. Palacios MD Dell Pediatric Research Institute Department of Nutritional Sciences University of Texas at Austin Austin, Texas USAPage B. Pennell MD Associate Professor in Neurology Director of Research, Division of Epilepsy Harvard Medical School Brigham and Women’s Hospital Boston, Massachusetts USADoodipala Samba Reddy PhD, RPh Associate Professor Department of Neuroscience and Experimental Therapeutics College of Medicine Texas A&M Health Science Center Bryan, Texas USALine S. Røste MD, PhD Senior Consultant Department of Neurology Oslo University Hospital – Rikshospitalet Oslo, NorwayAnne Sabers MD, DMSc Epilepsy Clinic Department of Neurology University State Hospital – Rigshospitalet Copenhagen, DenmarkSigrid Svalheim MD, PhD Senior Consultant Department of Neurology Oslo University Hospital – Rikshospitalet Oslo, NorwayErik Taubøll MD, PhD Professor of Neurology and Section Head Department of Neurology Oslo University Hospital – Rikshospitalet Oslo, NorwayKari A. Teramo MD, PhD Department of Obstetrics and Gynecology Helsinki University Central Hospital Helsinki, FinlandSanjeev V. Thomas MD, DM Professor of Neurology Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, IndiaTorbjörn Tomson MD, PhD Professor of Neurology and Epileptology Department of Clinical Neuroscience Karolinska Institutet Stockholm, SwedenBogdan J. Wlodarczyk Assistant Professor Dell Pediatric Research Institute Department of Nutritional Sciences University of Texas at Austin Austin, Texas USA

CHAPTER 1

Gender Difference in Epidemiology and Comorbidities of Epilepsy

Ettore Beghi1 and Massimiliano Beghi2

1 Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy2 Dipartimento di Salute Mentale, Ospedale “G. Salvini”, Garbagnate Milanese, Italy

Background and important detail

Case history: A 54-year-old woman with multiple sclerosis was first seen at an epilepsy center seeking expert advice after having received a diagnosis of post-traumatic epilepsy by her general practitioner. At age 16 years the patient was a victim of a car accident during which she was seriously injured in her head. A temporo-occipital subdural hematoma was evacuated with uneventful follow-up. At that time, the patient received prophylactic treatment with phenytoin for 6 months. At age 30, she had blurring of vision for 3 weeks and at age 35 she had numbness in her left leg associated with mild weakness and urinary urgency. A diagnosis of multiple sclerosis was made based on history, clinical findings, and MRI evidence of demyelinating disease. Neurological symptoms and signs disappeared 1 month after onset and recurred, but with lower severity and duration, at age 45. In the 3 months preceding the epilepsy consultation, the patient experienced episodes characterized by visual hallucinations, each lasting 1–2 min. A follow-up MRI showed multiple areas of increased intensity with periventricular distribution in the frontal and occipital areas. The following questions were posed by the patient to the epileptologist. (1) Is this epilepsy or simply a relapse of her multiple sclerosis? (2) Is head trauma the most plausible cause of her seizures? (3) Should antiepileptic treatment be taken for life?