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Antiepileptic drug polytherapy in pregnant women with epilepsy
Author(s) -
Vajda F. J. E.,
O’Brien T. J.,
Graham J. E.,
Hitchcock A. A.,
Lander C. M.,
Eadie M. J.
Publication year - 2018
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12965
Subject(s) - lamotrigine , topiramate , levetiracetam , pregnancy , epilepsy , medicine , antiepileptic drug , anticonvulsant , drug , anesthesia , obstetrics , pediatrics , pharmacology , psychiatry , genetics , biology
Objective To study seizure control and rates of foetal malformation in pregnancies of women with epilepsy treated with antiepileptic drug polytherapy. Methods The use of conventional statistical methods to analyse the Australian Pregnancy Register records of 1810 pregnancies in women with epilepsy, 508 treated with antiepileptic drug polytherapy. Results Polytherapy‐treated pregnancies were less often seizure free than monotherapy‐treated ones, for both focal (36.0% vs 51.9%: P < .05) and primary generalized epilepsies (41.1% vs 69.3%; P < .05). Drug combinations with dissimilar and similar mechanisms of action achieved similar rates of seizure freedom during pregnancy (36.3% vs 38.3%). The increased rate of malformed foetuses in polytherapy pregnancies depended on valproate or topiramate being in the drug combinations. The combinations of lamotrigine and levetiracetam offered the chance of seizure control and foetal safety. Conclusions In pregnancy, the use of a ntiepileptic drug combinations is not necessarily disadvantageous to mother and foetus if valproate and topiramate are avoided.