1
|
Braillon A. Risk minimisation measures to prevent topiramate use during pregnancy: maximal delay, minimal actionability. BMJ 2024; 386:q1813. [PMID: 39159952 DOI: 10.1136/bmj.q1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
|
2
|
Nguyen AT, Curtis KM, Tepper NK, Kortsmit K, Brittain AW, Snyder EM, Cohen MA, Zapata LB, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep 2024; 73:1-126. [PMID: 39106314 PMCID: PMC11315372 DOI: 10.15585/mmwr.rr7304a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1-103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.
Collapse
Affiliation(s)
- Antoinette T. Nguyen
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kathryn M. Curtis
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Naomi K. Tepper
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Anna W. Brittain
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Emily M. Snyder
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Megan A. Cohen
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Lauren B. Zapata
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Maura K. Whiteman
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| |
Collapse
|
3
|
Li Q, Zhang Z, Fang J. Hormonal Changes in Women with Epilepsy. Neuropsychiatr Dis Treat 2024; 20:373-388. [PMID: 38436042 PMCID: PMC10906279 DOI: 10.2147/ndt.s453532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024] Open
Abstract
Epilepsy is a prevalent neurological disorder among women globally, often requiring long-term treatment. Hormonal fluctuations in women with epilepsy (WWE) can have reciprocal effects on epilepsy and antiseizure medications (ASMs), posing significant challenges for WWE. Notably, WWE commonly experience endocrine alterations such as thyroid dysfunctions, low bone metabolism, and reproductive hormone irregularities. On the one hand, the presence of hormones in women with epilepsy affects their susceptibility to epilepsy as well as the metabolism of antiseizure medications in various ways. On the other hand, epilepsy itself and the use of antiseizure medications impact the production, secretion, and metabolism of hormones, resulting in low fertility, increased risk of pregnancy complications, negative offspring outcomes, and so on. In order to develop more precise treatment strategies in the future, it is necessary to comprehend the explicit relationships between hormones, epilepsy, and antiseizure medications, as well as to elucidate the currently known mechanisms underlying these interactions.
Collapse
Affiliation(s)
- Qiwei Li
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
| | - Zhiyun Zhang
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
- Department of Neurology, The Mianyang Central Hospital, Mianyang, Sichuan Province, 621000, People’s Republic of China
| | - Jiajia Fang
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
| |
Collapse
|
4
|
Lo CB, Conrad B, Debs A, Herbst J, Kulkarni N, Nelson DM, Wentzel E, Cohen DM, Patel AD. Counseling on the Need for Folic Acid in Adolescents With Epilepsy. Neurol Clin Pract 2023; 13:e200177. [PMID: 37529297 PMCID: PMC10389172 DOI: 10.1212/cpj.0000000000200177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/09/2023] [Indexed: 08/03/2023]
Abstract
Background and Objectives Folic acid is an important supplement to take for women with epilepsy on antiseizure medications (ASMs). Determination of baseline counseling given to women with epilepsy and the association with folic acid being recommended were evaluated. Factors surrounding the association were reviewed. Methods An exploratory retrospective review of women with epilepsy seen at a large Midwestern pediatric institution was performed between January 2018 and January 2020. Results Patients who received preconception counseling were more likely to be given a recommendation to take folic acid. Patients on more than 1 ASM were likely to receive counseling. Patient age and race were associated with having folic acid recommended. Discussion Providing preconception counseling for women with epilepsy is associated with an increased recommendation and prescription of folic acid. Further evaluation into possible disparities to receiving a folic acid recommendation is needed.
Collapse
Affiliation(s)
- Charmaine B Lo
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Bailey Conrad
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Andrea Debs
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - James Herbst
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Neil Kulkarni
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Dustin Mark Nelson
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Evelynne Wentzel
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Daniel M Cohen
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Anup D Patel
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
5
|
Kirkpatrick L, Waters J, O'Neal MA. Preventive Approaches in Women's Neurology: Prepartum, Pregnancy, and Postpartum. Semin Neurol 2022; 42:665-678. [PMID: 36216357 DOI: 10.1055/a-1958-0633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Women's neurology is the subspecialty within neurology concerned with the distinct healthcare needs of women. In this article, we review current literature and expert management strategies regarding disease-specific neurologic concerns of women, with an emphasis on issues related to contraception, pregnancy, and lactation. Health conditions that we discuss in this article include epilepsy, headache, stroke, multiple sclerosis, and Chiari I malformation. Current findings on neurologic disease in women suggest that many women with neurologic disease can safely manage their disease during pregnancy and have healthy children, though pregnancy planning is important in many conditions to mitigate risks and effective contraceptive management is important when pregnancy prevention is desired.
Collapse
Affiliation(s)
- Laura Kirkpatrick
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Janet Waters
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Angela O'Neal
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
6
|
Touhami YOH, Benhaddouch Y, Hammani Z, Bout A, Aarab C, Aalouane R. Les contraceptifs hormonaux en interaction avec les thymorégulateurs antiépileptiques et le lithium : quelles implications thérapeutiques ? Therapie 2022:S0040-5957(22)00122-6. [PMID: 36031435 DOI: 10.1016/j.therap.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
|
7
|
Bulbul M, Nacar MC, Aydin Turk B, Karacor T, Onderci M, Parlar A, Kirici P, Ucar C. The effect of carbamazepine, which increases oestrogen destruction, on the endometriotic implants; an experimental rat model. J OBSTET GYNAECOL 2022; 42:1261-1267. [PMID: 34581245 DOI: 10.1080/01443615.2021.1953453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We planned this experimental study to investigate the effect of carbamazepine (CMZ) on the endometriotic implants. Rats were randomised into four groups after endometriosis surgery. Drinking water was given to the sham group, 0.2 mg/kg oestradiol valerate (EV) to the EV group, 100 mg/kg/day CMZ to the CMZ group, and 0.2 mg/kg EV and 100 mg/kg/day CMZ to the EV-CMZ group. The endometrium of the rats using CMZ stained more intensely with cytochrome P450-3A4 (CYP3A4) enzyme. No endometrial hyperplasia was found in these rats. Endometriotic implants weight was found to be higher in these rats. There was no difference between the groups in terms of staining of the endometriotic implants with CYP3A4 enzyme. Endometriotic implants were less stained with the CYP3A4 enzyme than the endometrium. According to our results, CMZ does not increase the destruction of oestrogen in the endometriotic implants, unlike the endometrium. It may even cause the lesion to enlarge.Impact statementWhat is already known on this subject? Endometriosis is an oestrogen-dependent, progressive disease. Carbamazepine (CMZ) is known to increase oestrogen degradation by activating the cytochrome P450-3A4 (CYP3A4) enzyme. CMZ can be used in the treatment of endometriosis because it increases oestrogen breakdown in tissues.What do the results of this study add? CMZ can protect the endometrium against hyperplasia by increasing the amount of CYP3A4 enzyme in the endometrium. This effect could not be demonstrated in the endometriotic implants. The presence of CYP3A4 enzyme less in the endometriotic implants than in the endometrium may explain this situation. In addition, the fact that CMZ does not increase the enzyme in the endometriotic implants may contribute to this situation.What are the implications of these findings for clinical practice and/or further research? CMZ may not be a suitable alternative in the treatment of endometriosis. However, it may protect against endometrial hyperplasia. Clinical studies are needed for this effect.
Collapse
Affiliation(s)
- Mehmet Bulbul
- Faculty of Medicine, Department of Obstetrics and Gynecology, Adiyaman University, Adiyaman, Turkey
| | - Mehmet Can Nacar
- Faculty of Medicine, Department of Obstetrics and Gynecology, Adiyaman University, Adiyaman, Turkey
| | - Bilge Aydin Turk
- Faculty of Medicine, Department of Pathology, Adiyaman University, Adiyaman, Turkey
| | - Talip Karacor
- Faculty of Medicine, Department of Obstetrics and Gynecology, Adiyaman University, Adiyaman, Turkey
| | - Muhittin Onderci
- Faculty of Medicine, Department of Biochemistry, Adiyaman University, Adiyaman, Turkey
| | - Ali Parlar
- Faculty of Medicine, Department of Pharmacology, Adiyaman University, Adiyaman, Turkey
| | - Pınar Kirici
- Faculty of Medicine, Department of Obstetrics and Gynecology, Adiyaman University, Adiyaman, Turkey
| | - Cihat Ucar
- Faculty of Medicine, Department of Physiology, Adiyaman University, Adiyaman, Turkey
| |
Collapse
|
8
|
Nucera B, Brigo F, Trinka E, Kalss G. Treatment and care of women with epilepsy before, during, and after pregnancy: a practical guide. Ther Adv Neurol Disord 2022; 15:17562864221101687. [PMID: 35706844 PMCID: PMC9189531 DOI: 10.1177/17562864221101687] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/03/2022] [Indexed: 01/16/2023] Open
Abstract
Women with epilepsy (WWE) wishing for a child represent a highly relevant subgroup of epilepsy patients. The treating epileptologist needs to delineate the epilepsy syndrome and choose the appropriate anti-seizure medication (ASM) considering the main goal of seizure freedom, teratogenic risks, changes in drug metabolism during pregnancy and postpartum, demanding for up-titration during and down-titration after pregnancy. Folic acid or vitamin K supplements and breastfeeding are also discussed in this review. Lamotrigine and levetiracetam have the lowest teratogenic potential. Data on teratogenic risks are also favorable for oxcarbazepine, whereas topiramate tends to have an unfavorable profile. Valproate needs special emphasis. It is most effective in generalized seizures but should be avoided whenever possible due to its teratogenic effects and the negative impact on neuropsychological development of in utero-exposed children. Valproate still has its justification in patients not achieving seizure freedom with other ASMs or if a woman decides to or cannot become pregnant for any reason. When valproate is the most appropriate treatment option, the patient and caregiver must be fully informed of the risks associated with its use during pregnancies. Folate supplementation is recommended to reduce the risk of major congenital malformations. However, there is insufficient information to address the optimal dose and it is unclear whether higher doses offer greater protection. There is currently no general recommendation for a peripartum vitamin K prophylaxis. During pregnancy most ASMs (e.g. lamotrigine, oxcarbazepine, and levetiracetam) need to be increased to compensate for the decline in serum levels; exceptions are valproate and carbamazepine. Postpartum, baseline levels are reached relatively fast, and down-titration is performed empirically. Many ASMs in monotherapy are (moderately) safe for breastfeeding and women should be encouraged to do so. This review provides a practically oriented overview of the complex management of WWE before, during, and after pregnancy.
Collapse
Affiliation(s)
- Bruna Nucera
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the ERN EpiCARE, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the ERN EpiCARE, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria
| |
Collapse
|
9
|
Lazorwitz A, Pena M, Sheeder J, Teal S. Effect of Topiramate on Serum Etonogestrel Concentrations Among Contraceptive Implant Users. Obstet Gynecol 2022; 139:579-587. [PMID: 35594123 PMCID: PMC9140306 DOI: 10.1097/aog.0000000000004697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate topiramate and etonogestrel pharmacokinetic interactions in contraceptive implant users. METHODS We conducted a prospective, noninferiority study with healthy women using etonogestrel implants continuously for 12-36 months. We measured baseline serum etonogestrel concentrations and then began a 6-week titrated topiramate regimen to standard migraine (100 mg/day) and epilepsy (400 mg/day) dosages. We repeated serum etonogestrel concentrations at 3 weeks (100 mg/day), 4 weeks (200 mg/day), and 6 weeks (400 mg/day) of topiramate therapy. We measured etonogestrel using a validated liquid chromatography-tandem, mass-spectrometry assay and tested for noninferiority (less than 30% decrease) in serum etonogestrel concentrations from baseline. RESULTS We enrolled 48 total participants; 32 completed 3 weeks, 31 completed 4 weeks, and 27 completed all follow-up visits. Participants' median age was 25.3 years (range 18.3-37.2), median body mass index (BMI) was 25.5 kg/m2 (range 18.7-42.2), and median duration of implant use was 24 months (range 12-36). Median etonogestrel concentrations were 142 pg/mL (range 76.2-771) at baseline, 126 pg/mL (range 72.4-585) at 3 weeks, 119 pg/mL (range 65.6-542) at 4 weeks, and 105 pg/mL (46.2-859) at 6 weeks. The 95% CIs for mean percent change in serum etonogestrel concentrations from baseline were [-37.3%+16.9%], [-45.4%+5.2%], and [-66.8%+24.8%] at 3 weeks, 4 weeks, and 6 weeks, respectively. Excluding one participant who had a serum etonogestrel concentration less than 90 pg/mL at baseline, 30.8% of participants (8/26, 95% CI 14.3-51.8%) had a serum etonogestrel concentration less than 90 pg/mL at 6 weeks. CONCLUSION Though only a mild enzyme-inducing antiepileptic drug, concomitant topiramate use led to inferior serum etonogestrel concentrations among implant users, with a significant proportion reaching etonogestrel concentrations below the threshold for ovulatory suppression when taking antiepileptic dosages of topiramate. FUNDING SOURCE This study was primarily funded through an Investigator-Initiated Study grant from Merck Sharp & Dohme Corp [MISP#57073]. This work was also supported by NIH/NCATS CTSA Grant Number UL1 TR001082 and NICHD K12 Women's Reproductive Health Research Scholar Program (grant number 5K12HD001271-18). CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03335163.
Collapse
Affiliation(s)
- Aaron Lazorwitz
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning
| | - Morgan Pena
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning
| | - Jeanelle Sheeder
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning
| | - Stephanie Teal
- University Hospitals Cleveland Medical Center and Case Western Reserve University, Department of Obstetrics and Gynecology
| |
Collapse
|
10
|
King A, Gerard EE. Contraception, fecundity, and pregnancy in women with epilepsy: an update on recent literature. Curr Opin Neurol 2022; 35:161-168. [PMID: 35191408 PMCID: PMC9230745 DOI: 10.1097/wco.0000000000001039] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Caring for women with epilepsy requires specialized knowledge about potential teratogenicity of antiseizure medications, interactions with hormonal contraception, and pregnancy outcomes. RECENT FINDINGS There has been an improvement in understanding the cognitive outcomes of infants exposed in utero in recent years. Folic acid supplementation helps mitigate the cognitive teratogenicity of antiseizure medications. Recent updates provide reassurance that seizure frequency tends to remain stable throughout pregnancy. There is conflicting evidence about the fecundity impact of epilepsy and antiseizure medications in women with epilepsy. SUMMARY Recent research highlights the importance of early counseling about the risks and interactions of contraception, pregnancy, and antiseizure medications. More research is needed to understand fertility in women with epilepsy.
Collapse
Affiliation(s)
- Alexa King
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | |
Collapse
|
11
|
Gosset A, Denuelle M, Valton L, Sommet A, Bénévent J, Tremollières F. Interactions between antiseizure medications and contraception: A study about the knowledge of patients and their specialist physicians. Epilepsy Behav 2022; 129:108627. [PMID: 35240507 DOI: 10.1016/j.yebeh.2022.108627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 11/03/2022]
Abstract
Planning pregnancy is very important for women with epilepsy (WWE), because of the potential teratogenic effects and neurodevelopmental disorders of different antiseizure medications (ASMs). Nevertheless, contraception in WWE can be challenging due to the existence of drug interactions between ASMs and hormonal contraception. The aim of this study was to assess women's knowledge of potential interactions between their ASMs and contraceptive options. The second objective was to assess neurologist's knowledge of the potential interactions between ASMs and contraceptive methods. An anonymous online survey was proposed to reproductive-age WWE during consultation with their neurologist. Another online survey was proposed to neurologists. These surveys were performed through a French regional medical network. A total of 79 patients agreed to respond to the survey. Forty-nine women used lamotrigine alone or in combination, 15 used an enzyme-inducing ASM alone or in combination, 13 used non-enzyme-inducing ASM and 2 used both lamotrigine and an enzyme-inducing ASM. Half of the WWE had mistaken beliefs about interactions between their ASM and contraception. Among them, 35% of the women treated with an enzyme-inducing ASM were unaware of a potential decreased efficacy of hormonal contraception. Moreover, 51% of the women who were taking lamotrigine did not know that combined hormonal contraception might decrease the efficacy of their ASM. On the other hand, 64.5% of WWE without an enzyme-inducing ASM wrongly thought that their ASM can decrease their hormonal contraceptive efficacy. A total of 20 neurologists answered the online survey. It revealed specific gaps concerning interactions between ASM and contraceptives; in fact, 35% of answers concerning the identification of specific enzyme-inducing ASMs were wrong. This study therefore highlights the need for educational efforts for both WWE and their physicians regarding drug interactions between ASMs and hormonal contraceptives.
Collapse
Affiliation(s)
- Anna Gosset
- Centre de Ménopause et Maladies osseuses et métaboliques, CHU-Toulouse, 330 avenue de Grande Bretagne, TSA, 70034 31059 Toulouse, France.
| | - Marie Denuelle
- Explorations Neurophysiologiques, Département de Neurologie, CHU-Toulouse, & Centre de Recherche Cerveau et Cognition, (CerCo), UMR 5549, CNRS, Université de Toulouse, 330 avenue de Grande Bretagne, TSA, 70034 31059 Toulouse, France
| | - Luc Valton
- Explorations Neurophysiologiques, Département de Neurologie, CHU-Toulouse, & Centre de Recherche Cerveau et Cognition, (CerCo), UMR 5549, CNRS, Université de Toulouse, 330 avenue de Grande Bretagne, TSA, 70034 31059 Toulouse, France
| | - Agnès Sommet
- Service de Pharmacologie Médicale et Clinique, Équipe CERPOP - SPHERE INSERM, Université Paul-Sabatier, Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France
| | - Justine Bénévent
- Service de Pharmacologie Médicale et Clinique, Équipe CERPOP - SPHERE INSERM, Université Paul-Sabatier, Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France
| | - Florence Tremollières
- Centre de Ménopause et Maladies osseuses et métaboliques, CHU-Toulouse, 330 avenue de Grande Bretagne, TSA, 70034 31059 Toulouse, France
| |
Collapse
|
12
|
Contraception and Reproductive Health Care for Adolescent and Young Adult Women with Epilepsy. J Pediatr 2022; 241:229-236. [PMID: 34728232 DOI: 10.1016/j.jpeds.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
|
13
|
Abstract
IMPORTANCE Many women spend a substantial proportion of their lives preventing or planning for pregnancy, and approximately 87% of US women use contraception during their lifetime. OBSERVATIONS Contraceptive effectiveness is determined by a combination of drug or device efficacy, individual fecundability, coital frequency, and user adherence and continuation. In the US, oral contraceptive pills are the most commonly used reversible method of contraception and comprise 21.9% of all contraception in current use. Pregnancy rates of women using oral contraceptives are 4% to 7% per year. Use of long-acting methods, such as intrauterine devices and subdermal implants, has increased substantially, from 6% of all contraceptive users in 2008 to 17.8% in 2016; these methods have failure rates of less than 1% per year. Estrogen-containing methods, such as combined oral contraceptive pills, increase the risk of venous thrombosis from 2 to 10 venous thrombotic events per 10 000 women-years to 7 to 10 venous thrombotic events per 10 000 women-years, whereas progestin-only and nonhormonal methods, such as implants and condoms, are associated with rare serious risks. Hormonal contraceptives can improve medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder. Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences. CONCLUSIONS AND RELEVANCE Oral contraceptive pills are the most commonly used reversible contraceptives, intrauterine devices and subdermal implants have the highest effectiveness, and progestin-only and nonhormonal methods have the lowest risks. Optimal contraceptive selection incorporates patient values and preferences.
Collapse
Affiliation(s)
- Stephanie Teal
- Department of OB/GYN, University Hospitals Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Alison Edelman
- Department of OB/GYN, Oregon Health & Science University, Portland
| |
Collapse
|
14
|
Herzog AG, Mandle HB, MacEachern DB. Differential risks of changes in seizure frequency with transitions between hormonal and non-hormonal contraception in women with epilepsy: A prospective cohort study. Epilepsy Behav 2021; 120:108011. [PMID: 33964535 DOI: 10.1016/j.yebeh.2021.108011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
This prospective, observational, cohort study of 101 women with epilepsy (WWE) assesses the seizure safety of systemic hormonal contraception (HC) versus non-HC (NHC). It reports risks of changes in seizure frequency associated with transition from NHC to HC relative to HC to NHC for (1) proportions of WWE with ≥50% increase and decrease in seizure frequency, (2) changes in seizure frequency, (3) changes in seizure severity, and 4) changes in AED regimen during the study. In comparing NHC to HC versus HC to NHC, NHC to HC had greater risk of ≥50% increase in seizure frequency: RR = 1.98 (1.07-3.64), p = 0.03 and lower risk of ≥50% decrease in seizure frequency: RR = 0.42 (0.22 = 0.83), p = 0.01. These risks were particularly notable for oral contraceptive pill: RR = 2.91 (1.26-6.72), p = 0.01 and RR = 0.54 (0.30-0.97), p = 0.04, respectively. Median monthly seizure frequency (MMSF) increased 302.0% (p = 0.0019) with transition from NHC to HC. MMSF decreased 81.9% with change from HC to NHC (p = 0.001). RR for change in seizure type from milder to more severe type was greater for NHC to HC: RR = 3.32 (1.07-10.27), p = 0.04. Change in AED regimen was not a significant factor. The findings suggest further prospective study to assess whether HC, especially oral contraceptive pill, poses a greater risk of increased seizures than NHC.
Collapse
Affiliation(s)
- Andrew G Herzog
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA, United States.
| | - Hannah B Mandle
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Devon B MacEachern
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA, United States
| |
Collapse
|
15
|
Bulbul M, Aydın Turk B, Karaçor T, Onderci M, Nacar MC, Parlar A, Ucar C. Carbamazepine protects the endometrium against negative effects of estrogen in rats. Biotech Histochem 2021; 97:254-260. [PMID: 34162294 DOI: 10.1080/10520295.2021.1942988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Carbamazepine (CMZ) increases estrogen metabolism by inducing cytochrome P450 (CYP3A4). We investigated whether CMZ is protective against endometrial hyperplasia (EH). We used 32 female Wistar albino rats divided into four equal groups: the control group received drinking water, the estradiol valerate (EV) group was given EV, the CMZ group was given CMZ, and the EV + CMZ group was given both EV and CMZ. After 30 days the uteri of the rats were removed and serum estrogen and progesterone levels were measured, and endometrial tissue characteristics were evaluated. CYP3A4 expression was assessed using immunohistochemistry. Serum estrogen levels were lowest in the EV group and highest in the CMZ group. Serum progesterone levels were similar among all groups. Glandular density, a proxy measure of EH, was highest in the EV group and lowest in the EV + CMZ group. EH was detected in six of eight rats (75%) in the EV group and two of eight rats (25%) in the EV + CMZ group. Immunohistochemical staining revealed no significant difference in CYP3A4 expression among the four groups. CMZ reduced the negative effect of high dose estrogen that is not balanced by progesterone on the endometrium in rats. The effect likely is probably due to the CYP3A4 enzyme activator effect. CMZ may be protective against EH in high risk women, although confirmation is required.
Collapse
Affiliation(s)
- Mehmet Bulbul
- Department of Obstetrics and Gynecology, Adıyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Bilge Aydın Turk
- Department of Pathology, Adıyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Talip Karaçor
- Department of Obstetrics and Gynecology, Adıyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Muhittin Onderci
- Department of Biochemistry, Adıyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Mehmet Can Nacar
- Department of Obstetrics and Gynecology, Adıyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Ali Parlar
- Department of Pharmacology, Adıyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Cihat Ucar
- Department of Physiology, Adıyaman University Faculty of Medicine, Adiyaman, Turkey
| |
Collapse
|
16
|
A Pharmacoepidemiologic Approach to Evaluate Real-world Effectiveness of Hormonal Contraceptives in the Presence of Drug-drug Interactions. Epidemiology 2021; 32:268-276. [PMID: 33196560 PMCID: PMC7850590 DOI: 10.1097/ede.0000000000001302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Accurate estimation of conception is critical in the assessment of the effects of drugs used during pregnancy or to prevent pregnancy. In a novel application, we studied the effectiveness of oral contraceptives (OCs), where misclassification of conception relative to OC exposure may obscure effect estimates.
Collapse
|
17
|
Decker BM, Acton EK, Davis KA, Willis AW. Inconsistent reporting of drug-drug interactions for hormonal contraception and antiepileptic drugs - Implications for reproductive health for women with epilepsy. Epilepsy Behav 2021; 114:107626. [PMID: 33309232 PMCID: PMC7855647 DOI: 10.1016/j.yebeh.2020.107626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
Drug compendia are the source of safety prescribing information. We assessed the reporting concordance of drug-drug interactions between hormonal contraception and antiepileptic drugs (AEDs) among eight leading international drug compendia. Antiepileptic drugs reported to interact with ≥1 form of hormonal contraception were reviewed. Scaled concordance was quantified using linearly weighted percent agreement (wPA). Differences in interaction severity rankings between hormonal contraception forms were evaluated using the Wilcoxon signed-rank test. There was high agreement among compendia for interactions of combined hormonal contraception interactions with AEDs (wPA = 0.82-0.84), especially potent enzyme-inducing AEDs (wPA = 0.89). However, concordance was reduced for AED interactions with progestin-only contraception (wPA = 0.69-0.81). Extreme interaction reporting discrepancies were found for less potent enzyme-inducing AEDs. The greatest variability in interaction reporting was observed for injectable and intrauterine contraception (wPA = 0.69 and 0.70, respectively), which are the only hormonal contraception options currently classified as not interacting with enzyme-inducing AEDs. Drug-drug interaction reporting variability can have major clinical implications and highlights critical knowledge gaps in the care of women with epilepsy of childbearing age. Further research on AED-contraceptive interactions is needed to standardize compendia reporting and enhance evidence-based clinical guidelines for women with epilepsy.
Collapse
Affiliation(s)
- Barbara M Decker
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Emily K Acton
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Kathryn A Davis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| |
Collapse
|
18
|
Marnach ML, Gave CJ, Casey PM. Contraceptive Challenges in Women With Common Medical Conditions. Mayo Clin Proc 2020; 95:2525-2534. [PMID: 33153637 DOI: 10.1016/j.mayocp.2020.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022]
Abstract
Women have the opportunity to meet personal contraceptive goals with convenient, highly reliable, and easily reversible methods. Long-acting reversible contraception represents an increasingly popular option for most women throughout the reproductive lifespan. Nonetheless, many women and their health care providers are challenged by coexisting medical issues. We aim to help clinicians individualize contraception and use shared decision-making to enhance patient satisfaction and continuation with their method.
Collapse
Affiliation(s)
- Mary L Marnach
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN.
| | - Cassandra J Gave
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | - Petra M Casey
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| |
Collapse
|
19
|
Katyal R, Singhal D. Managing Transition of Care in Adolescent Females with Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractTransition of care from pediatric epilepsy clinics to adult health care is often a challenging process, especially due to limited availability of relevant guidelines. It carries even more significant implications in specific population subsets such as adolescent females, given a myriad of physiological as well as psychosocial changes seen in this age group. Women with epilepsy face distinct challenges because of hormonal variations on seizures (catamenial epilepsy). Furthermore, seizures and antiepileptic drugs impact menstruation, pregnancy, and lactation. These patients are at a higher risk for developing mental health problems, and a close follow-up with appropriate screening for psychiatric disorders is prudent.Several factors contributing to poor transition of care include limited availability of a multidisciplinary set-up and social-support services, delayed referral to specialist(s), and tendency for treatment nonadherence. In this review, we discuss the current scenario of transition of care in adolescent females with epilepsy and explore avenues for improvement based on our subspecialty clinic experiences. We illustrate the value of interdisciplinary care proactively involving neurologists/epileptologists, primary care physicians, obstetricians–gynecologists, and relevant social services and emphasize shared decision-making, effective contraceptive methods, preconceptual counseling, maintenance of bone-health, and enhanced quality of life.
Collapse
Affiliation(s)
- Roohi Katyal
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Divya Singhal
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| |
Collapse
|
20
|
Gynecologic Management of Adolescents and Young Women With Seizure Disorders: ACOG Committee Opinion, Number 806. Obstet Gynecol 2020; 135:e213-e220. [PMID: 32332416 DOI: 10.1097/aog.0000000000003827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Seizure disorders frequently are diagnosed and managed during adolescence; therefore, obstetrician-gynecologists who care for adolescents should be familiar with epilepsy and other seizure disorders, as well as antiepileptic drugs. Patients diagnosed with seizure disorders during childhood may have increased seizure activity with puberty and menarche due to the neuroactive properties of endogenous steroid hormones. Compared with patients without epilepsy, patients with epilepsy are more likely to experience anovulatory cycles, irregular menstrual bleeding, and amenorrhea. Although hormonal suppression should not be initiated before puberty or menarche, prepubertal counseling may be appropriate, and obstetrician-gynecologists may work with young patients and their families to develop a plan to initiate with menarche. Additionally, obstetrician-gynecologists should be aware of any medication changes, including antiepileptics, for adolescent patients with seizure disorders. Research on hormonal therapy for the treatment of epilepsy is scant; however, the anticonvulsant properties of various progestins have been explored as potential treatment. There is no conclusive evidence that combination hormonal contraception increases epileptic seizures, and epilepsy itself poses no increased risk of an adverse outcome for those using combined oral contraceptive pills, the contraceptive patch, or a contraceptive ring. Because many antiepileptic drugs are teratogenic, discussing sexual health with and providing effective contraceptive choices to this population is critical. Obstetrician-gynecologists should work with patients with seizure disorders to develop a plan when pregnancy occurs.
Collapse
|
21
|
Wu K, Hirsch LJ, Babl FE, Josephson SA. Choosing Anticonvulsant Medications to Manage Status Epilepticus. N Engl J Med 2020; 382:2569-2572. [PMID: 32579819 DOI: 10.1056/nejmclde2004317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
22
|
Abstract
Common genetic generalised epilepsy syndromes encountered by clinicians include childhood and juvenile absence epilepsies, juvenile myoclonic epilepsy and generalised tonic-clonic seizures on awakening. Treatment of these syndromes involves largely the use of broad-spectrum antiseizure drugs. Those effective for the generalised epilepsies include sodium valproate, phenobarbital, ethosuximide, clobazam, clonazepam, lamotrigine, levetiracetam, topiramate, zonisamide and, more recently, perampanel and brivaracetam. Results from the few rigorous studies comparing outcomes with drugs for genetic generalised epilepsies show valproate to be the most effective. The majority of patients with genetic generalised epilepsy syndromes will become seizure free on antiseizure monotherapy; those for whom control proves elusive may benefit from combination regimens. Early counselling regarding management may assist the patient to come to terms with their diagnosis and improve long-term outcomes. Treatment can be lifelong in some individuals, although others may remain seizure free without medication. Choice of antiseizure medication depends on the efficacy for specific seizure types, as well as tolerability. For patients prescribed comedication, drug interactions should be considered. In particular, for young women taking oral hormonal contraceptives, ≥ 200 mg/day of topiramate can decrease the circulating concentration of ethinylestradiol and ≥ 12 mg/day of perampanel can induce levonorgestrel metabolism. The use of valproate in women of childbearing potential is limited by associated teratogenic and neurodevelopmental effects in offspring. Given that valproate is often the antiseizure drug of choice for genetic generalised epilepsies, this creates a dilemma for patients and clinicians. Decision making can be aided by comprehensive assessment and discussion of treatment options. Psychiatric comorbidities are common in adolescents and adults with genetic generalised epilepsies. These worsen the prognosis, both in terms of seizure control and quality of life. Attendant lifestyle issues can impact significantly on the individual and society. Frontal lobe dysfunction, which can present in patients with juvenile myoclonic epilepsy, can adversely affect the long-term outlook, regardless of the nature of seizure control. Ongoing management requires consideration of psychosocial and behavioural factors that can complicate diagnosis and treatment. An assured supportive attitude by the neurologist can be an important contributor to a positive outcome. The mechanisms underlying genetic generalised epilepsies, including genetic abnormalities, are unclear at present. As the pathophysiology is unravelled, this may lead to the development of novel therapies and improved outcomes for patients with these syndromes.
Collapse
Affiliation(s)
- Linda J Stephen
- West Glasgow Ambulatory Care Hospital, Dalnair St, Glasgow, G3 8SJ, UK.
| | | |
Collapse
|
23
|
ACOG Practice Bulletin No. 206: Use of Hormonal Contraception in Women With Coexisting Medical Conditions. Obstet Gynecol 2019; 133:e128-e150. [PMID: 30681544 DOI: 10.1097/aog.0000000000003072] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Although numerous studies have addressed the safety and effectiveness of hormonal contraceptive use in healthy women, data regarding women with underlying medical conditions or other special circumstances are limited. The U.S. Medical Eligibility Criteria (USMEC) for Contraceptive Use, 2016 (), which has been endorsed by the American College of Obstetricians and Gynecologists, is a published guideline based on the best available evidence and expert opinion to help health care providers better care for women with chronic medical problems who need contraception. The goal of this Practice Bulletin is to explain how to use the USMEC rating system in clinical practice and to specifically discuss the rationale behind the ratings for various medical conditions. Contraception for women with human immunodeficiency virus (HIV) (); the use of emergency contraception in women with medical coexisting medical conditions, including obesity, (); and the effect of depot medroxyprogesterone acetate (DMPA) on bone health () are addressed in other documents from the American College of Obstetricians and Gynecologists.
Collapse
|
24
|
Abstract
Association of Unintended Pregnancy With Spontaneous Fetal Loss in Women With Epilepsy: Findings of the Epilepsy Birth Control RegistryHerzog AG, Mandle HB, MacEachern DB. JAMA Neurol. 2018. doi:10.1001/jamaneurol.2018.3089. [Epub ahead of print] PMID: 30326007. IMPORTANCE If unintended pregnancy is common among women with epilepsy and is associated with increased risk of spontaneous fetal loss (SFL), it is important to develop guidelines for safe and effective contraception for this community. OBJECTIVE To assess whether planned pregnancy is a determinant of SFL in women with epilepsy. DESIGN, SETTING, AND PARTICIPANTS The Epilepsy Birth Control Registry conducted this web-based, retrospective survey between 2010 and 2014. It gathered demographic, epilepsy, antiepileptic drug (AED), contraceptive, and reproductive data from 1144 women with epilepsy in the community between ages 18 and 47 years. Data were analyzed between March 2018 and May 2018. Main outcomes and measures The primary outcome was the risk ratio (RR) with 95% confidence intervals (CIs) for SFL in unplanned versus planned pregnancies. The secondary outcome was the identification of some potentially modifiable variables (maternal age, pregnancy spacing, and AED category) of SFL versus live birth using binary logistic regression. RESULTS The participants were proportionally younger (mean [standard deviation] age, 28.5 [6.8] years), and 39.8% had household incomes of $25 000 or less. Minority women represented only 8.7% of the participants. There were 530 (66.8%) of 794 unplanned pregnancies and 264 (33.2%) of 794 planned pregnancies. The risk of SFL in 653 unaborted pregnancies in women with epilepsy was greater for unplanned (n = 137 of 391; 35.0%) than planned (n = 43 of 262; 16.4%) pregnancies (RR: 2.14; 95% CI: 1.59-2.90; P < .001). Regression analysis found that the risk of SFL was greater when planning was entered alone (odds ratio [OR], 2.75; 95% CI: 1.87-4.05; P < .001) and more so when adjusted for maternal age, interpregnancy interval, and AED category (OR: 3.57; 95% CI: 1.54-8.78; P = .003). Interpregnancy interval (OR: 2.878; 95% CI: 1.8094-4.5801; P = .008) and maternal age (OR: 0.957; 95% CI: 0.928-0.986 for each year from 18 to 47 years; P = .02), but not AED category, were also associated. The risk was greater when interpregnancy interval was less than 1 year (n = 56 of 122; 45.9%) versus greater than 1 year (n = 56 of 246; 22.8%; RR: 2.02; 95% CI: 1.49-2.72; P < .001). Relative to the younger than 18 years cohort (n = 15 of 29; 51.7%), the risks were lower for the intermediate older cohort aged 18 to 27 years (n = 118 of 400; 29.5%; RR: 0.57; 95% CI: 0.39-0.84; P < .004) and the cohort aged 28 to 37 years (n = 44 of 212; 20.8%; RR: 0.40; 95% CI: 0.26-0.62; P < .001) but not significantly different for the small number of participants in the aged 38 to 47 years cohort (n = 3 of 12; 25.0%). No individual AED category's SFL frequency differed significantly from the no AED category. CONCLUSIONS AND RELEVANCE The Epilepsy Birth Control Registry retrospective survey finding that unplanned pregnancy in women with epilepsy may double the risk of SFL warrants prospective investigation with outcome verification.
Collapse
|
25
|
Abstract
Juvenile myoclonic epilepsy (JME) is both a frequent and a very characteristic epileptic syndrome with female preponderance. Treatment of JME in women of childbearing potential must consider multiple factors such as desire for pregnancy, use of contraception, seizure control and previously used antiepileptic drugs (AEDs). Approximately 85% of cases are well controlled with valproate, which remains the reference AED in JME but is nowadays considered unsafe for the expecting mother and her fetus. The prescription of valproate is now severely restricted in women of childbearing potential but may still be considered, at the lowest possible dose and when pregnancies can be reliably planned, with temporary alternatives to valproate prescribed before fertilization. Alternatives have emerged, especially lamotrigine and levetiracetam, but also topiramate, zonisamide, and recently perampanel, but none of these AEDs can be considered fully safe in the context of pregnancy. In special settings, benzodiazepines and barbiturates may be useful. In some cases, combination therapy, especially lamotrigine and levetiracetam, may be useful or even required. However, lamotrigine may have the potential to aggravate JME, with promyoclonic effects. Carbamazepine, oxcarbazepine and phenytoin must be avoided. Valproate, levetiracetam, zonisamide, topiramate if the daily dose is ≤ 200 mg and perampanel if the daily dose is ≤ 10 mg do not affect combined hormonal contraception. Lamotrigine ≥ 300 mg/day has been shown to decrease levonorgestrel levels by 20% but does not compromise combined hormonal contraception. Patients with JME taking oral contraceptive should be counselled on the fact that the estrogenic component can reduce concentrations of lamotrigine by over 50%, putting patients at risk of increased seizures. Pregnancy is a therapeutic challenge, and the risk/benefit ratio for the mother and fetus must be considered when choosing the appropriate drug. Lamotrigine (< 325 mg daily in the European Registry of Antiepileptic Drugs in Pregnancy) and levetiracetam seem to be comparatively safer in pregnancy than other AEDs, especially topiramate and valproate. Plasma concentration of lamotrigine and levetiracetam decreases significantly during pregnancy, and dosage adjustments may be necessary. With persisting generalized tonic-clonic seizures, the combination of lamotrigine and levetiracetam offer the chance of seizure control and lesser risks of major congenital malformations. The risk of malformation increases when valproate or topiramate are included in the drug combination. In one study, the relative risk of autism and autism spectrum disorders (ASD) in children born to women with epilepsy (WWE) treated with valproate were, respectively, 5.2 for autism and 2.9 for ASD versus 2.12 for autism and 1.6 for ASD in WWE not treated with valproate. More studies are needed to assess the risk of autism with AEDs other than valproate. The current knowledge is that the risk appears to be double that in the general population. In patients with JME, valproate remains an essential and life-changing agent. The consequences of a lifetime of poorly controlled epilepsy need to be balanced against the teratogenic risks of valproate during limited times in a woman's life. The management of JME in WWE should include lifestyle interventions, with avoidance of sleep deprivation, and planned pregnancy.
Collapse
|
26
|
No. 313-Menstrual Suppression in Special Circumstances. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:e7-e17. [DOI: 10.1016/j.jogc.2018.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
27
|
Kirkham YA, Ornstein MP, Aggarwal A, McQuillan S. N° 313 - Suppression menstruelle en présence de circonstances particulières. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:e18-e29. [DOI: 10.1016/j.jogc.2018.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
28
|
Contraception for Women with Epilepsy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0250-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Posada Correa AM, Andrade Carrillo RA, Suarez Vega DC, Gómez Cano S, Agudelo Arango LG, Tabares Builes LF, Agudelo García ÁM, Uribe Villa E, Aguirre-Acevedo DC, López-Jaramillo C. Sexual and Reproductive Health in Patients with Schizophrenia and Bipolar Disorder. ACTA ACUST UNITED AC 2018; 49:15-22. [PMID: 32081203 DOI: 10.1016/j.rcp.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/05/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People with schizophrenia and bipolar disorder (BD) have a high risk of unwanted pregnancies and abortions, due to their condition of vulnerability or hypersexuality (common in BD). This is associated with difficulty in planning their actions and lack of sex education and counselling by medical personnel, and can lead to adverse obstetric outcomes and inability to care adequately for their children. OBJECTIVE To describe the characteristics in terms of sexual and reproductive health, and the use of contraception and counselling in psychiatric consultations, in a sample of patients with BD and schizophrenia in Medellin, Colombia. METHODS Observational cross-sectional study. We included the 160 participants from the clinical trial, "The effects of a multimodal intervention programme in patients with bipolar disorder and schizophrenia", who were recruited from the mood and psychosis disorders group clinic at Hospital Universitario de San Vicente Fundación in Medellin. They were contacted by phone by a third-year psychiatry resident, who applied a survey about the characteristics of their sex life, contraception and reproduction. RESULTS Almost all of the patients with schizophrenia were single, had no undergraduate studies and were unemployed. No significant differences were found regarding the age of starting sexual relations when comparing by diagnosis and gender. Almost all patients with schizophrenia and almost half of the patients with BD reported not having an active sexual life. Almost all of those who admitted to having an active sexual life claimed to always use contraception; in the BD group, only 48.8% of single women admitted to using contraception and a little over half of men stated that they used a condom when having sex. A quarter of the pregnancies were unplanned. Although the majority of the patients stated that they had never received information about family planning in the consultations with their psychiatrist, 57.4% of the patients with BD and 78.8% of those who had schizophrenia, considered themselves to be well informed on the subject. CONCLUSIONS Patients with mental illness have cognitive and behavioural alterations that affect their sexual and reproductive lives. Psychiatrists should therefore address this issue, to ensure education in areas such as contraception, family planning and sexually transmitted diseases and help safeguard the safety and quality of life of their patients.
Collapse
Affiliation(s)
- Ana María Posada Correa
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Sujey Gómez Cano
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Ángela María Agudelo García
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Esteban Uribe Villa
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Carlos López-Jaramillo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| |
Collapse
|
30
|
Atarodi-Kashani Z, Kariman N, Ebadi A, Majd HA, Beladi-Moghadam N, Hesami O. Exploring the perception of women with epilepsy about pregnancy concerns: a qualitative study. Electron Physician 2018; 10:6843-6852. [PMID: 29997770 PMCID: PMC6033129 DOI: 10.19082/6843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background and aim Epilepsy is a common neurological disorder in pregnancy, which is associated with increased maternal and fetal adverse outcomes. This study aimed to explore the reproductive healthcare needs of women with epilepsy before, during and after childbirth. Methods This was a qualitative study using a content analysis method. The study population was marital women with epilepsy in reproductive age (15–45 years) referred to Imam Hossein Hospital, Tehran, Iran. Participants were 16 women chosen using purposive sampling with the consideration of maximum variation in sampling. Semi-structured interviews were held with the participants until data saturation was reached. The data were analyzed using the content analysis method. The MAXQDA software, version 2010, was used for the management of data. Results The data analysis led to the development of two categories. The first one is named ‘resilience against threats to safe pregnancy’ and has the following subcategories: (1) real physical complications and perceived (mental) conditions due to unwanted pregnancies, (2) the predisposing factors of anxiety related to safe pregnancy, (3) perceived consequences of pregnancy’, and (4) the approach to encounter perceived consequences of pregnancy. The second category is called ‘adverse experiences under inefficient supportive systems’ and has the following subcategories: (1) the insufficiency of reproductive healthcare services for women with epilepsy, (2) doubt about the advantages and disadvantages of breastfeeding, (3) stigma as a block to the treatment of the postpartum depression, and (4) playing the motherhood role under the shadow of self-esteem to lack of self-esteem. Conclusion In the prenatal, natal and postnatal duration, because of supportive system disruption and not receiving proper consultation, participants were often worried about not being able to get favorable conditions for safe pregnancy and controlling process of their pregnancy. Therefore, they often experienced unwanted pregnancy. They were also concerned about the adverse fetal outcomes. In postpartum period, they often experienced postpartum depression and were very doubtful about breastfeeding.
Collapse
Affiliation(s)
- Zahra Atarodi-Kashani
- Ph.D. Candidate of Reproductive Health, International Branch, Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nourossadat Kariman
- Ph.D. of Reproductive Health, Assistant Professor, Midwifery and Reproductive Health Research Center, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Ph.D. of Nursing Education, Associate Professor, Behavioral Sciences Research Center, Life style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Alavai Majd
- Ph.D. of Biostatistics, Professor, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Beladi-Moghadam
- MD., Neurologist, Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Hesami
- MD., Neurologist, Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
|
32
|
Abstract
Sodium channel blockers have been the mainstay of the pharmacological management of focal and generalised tonic-clonic seizures for more than 70 years. The focus of this paper will be on phenytoin, carbamazepine, lamotrigine, oxcarbazepine, rufinamide, lacosamide and eslicarbazepine acetate. All these antiepileptic drugs have similar efficacy and share similar dose-dependent, adverse effect profiles, although phenytoin, carbamazepine and oxcarbazepine are more likely to cause idiosyncratic reactions than the others. With the exception of lamotrigine, rufinamide and lacosamide, all are enzyme inducers and most are minor teratogens; although data on teratogenicity are sparse with lacosamide and eslicarbazepine acetate. There is increasing evidence that these drugs differ mechanistically, with the newer agents, lacosamide and eslicarbazepine acetate, having their major pharmacological effect on the slow inactivation state of the sodium channel, which may be associated with better tolerability at higher dosage, although hard evidence in support of this observation is currently not available. Rufinamide is licensed only for Lennox-Gastaut syndrome in children aged 4 years and above. There is a move away from using enzyme inducers, particularly phenytoin and carbamazepine, in everyday clinical practice. There seems little doubt, however, that some sodium channel blockers will have an enduring place in the management of epilepsy well into the 21st century.
Collapse
Affiliation(s)
- Martin J Brodie
- Epilepsy Unit, West Glasgow ACH-Yorkhill, Dalnair Street, Glasgow, G3 8SJ, Scotland, UK.
| |
Collapse
|
33
|
The effect of carbamazepine on etonogestrel concentrations in contraceptive implant users. Contraception 2017; 95:571-577. [DOI: 10.1016/j.contraception.2017.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 11/18/2022]
|
34
|
Mandle HB, Cahill KE, Fowler KM, Hauser WA, Davis AR, Herzog AG. Reasons for discontinuation of reversible contraceptive methods by women with epilepsy. Epilepsia 2017; 58:907-914. [PMID: 28369748 DOI: 10.1111/epi.13734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To report the reasons for discontinuation of contraceptive methods by women with epilepsy (WWE). METHODS These retrospective data come from a web-based survey regarding the contraceptive practices of 1,144 WWE in the community, ages 18-47 years. We determined the frequencies of contraceptive discontinuations and the reasons for discontinuation. We compared risk ratios for rates of discontinuation among contraceptive methods and categories. We used chi-square analysis to test the independence of discontinuation reasons among the various contraceptive methods and categories and when stratified by antiepileptic drug (AED) categories. RESULTS Nine hundred fifty-nine of 2,393 (40.6%) individual, reversible contraceptive methods were discontinued. One-half (51.8%) of the WWE who discontinued a method discontinued at least two methods. Hormonal contraception was discontinued most often (553/1,091, 50.7%) with a risk ratio of 1.94 (1.54-2.45, p < 0.0001) compared to intrauterine devices (IUDs), the category that was discontinued the least (57/227, 25.1%). Among all individual methods, the contraceptive patch was stopped most often (79.7%) and the progestin-IUD was stopped the least (20.1%). The top three reasons for discontinuation among all methods were reliability concerns (13.9%), menstrual problems (13.5%), and increased seizures (8.6%). There were significant differences among discontinuation rates and reasons when stratified by AED category for hormonal contraception but not for any other contraceptive category. SIGNIFICANCE Contraception counseling for WWE should consider the special experience profiles that are unique to this special population on systemic hormonal contraception.
Collapse
Affiliation(s)
- Hannah B Mandle
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Kaitlyn E Cahill
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Kristen M Fowler
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - W Allen Hauser
- Gertrude H. Sergievsky Center, Mailman School of Public Health, Columbia University, New York, New York, U.S.A
| | - Anne R Davis
- Department of OBGYN, Columbia University Medical Center, New York, New York, U.S.A
| | - Andrew G Herzog
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| |
Collapse
|
35
|
Bangar S, Shastri A, El-Sayeh H, Cavanna AE. Women with epilepsy: clinically relevant issues. FUNCTIONAL NEUROLOGY 2017; 31:127-34. [PMID: 27678205 DOI: 10.11138/fneur/2016.31.3.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Women with epilepsy (WWE) face specific challenges throughout their lifespan due to the effects of seizures and antiepileptic drugs on hormonal function, potentially affecting both sexual and reproductive health. This review article addresses the most common issues of practical relevance to clinicians treating WWE: epidemiology and clinical presentations (including catamenial epilepsy), contraception, reproductive and sexual dysfunction, pregnancy, lactation, menopause-related issues (including bone health), and mental health aspects. Awareness of these gender-specific issues and implementation/adaptation of effective interventions for WWE results in significantly improved health-related quality of life in this patient population.
Collapse
|
36
|
Suto HS, Braga GC, Scarpellini GR, Takeuchi LI, Martins AP, Leite JP, Vieira CS. Neurologist knowledge about interactions between antiepileptic drugs and contraceptive methods. Int J Gynaecol Obstet 2016; 134:264-7. [DOI: 10.1016/j.ijgo.2016.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/02/2016] [Accepted: 05/23/2016] [Indexed: 11/15/2022]
|
37
|
Espinera AR, Gavvala J, Bellinski I, Kennedy J, Macken MP, Narechania A, Templer J, VanHaerents S, Schuele SU, Gerard EE. Counseling by epileptologists affects contraceptive choices of women with epilepsy. Epilepsy Behav 2016; 65:1-6. [PMID: 27829186 DOI: 10.1016/j.yebeh.2016.08.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/20/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There are several important interactions between antiepileptic drugs (AEDs) and hormonal contraception that need to be carefully considered by women with epilepsy (WWE) and their practitioners. Many AEDs induce hepatic enzymes and decrease the efficacy of hormonal contraception. In addition, estrogen-containing hormonal contraception can increase the metabolism of lamotrigine, the most commonly prescribed AED in women of childbearing age. The intrauterine device (IUD) is a highly effective form of reversible contraception without AED drug interactions that is considered by many to be the contraceptive of choice for WWE. Women with epilepsy not planning pregnancy require effective contraceptive counseling that should include discussion of an IUD. There are no guidelines, however, on who should deliver these recommendations. The objective of this study was to explore the hypothesis that contraceptive counseling by a neurologist can influence the contraceptive choices of WWE. In particular, we explored the relationship between contraceptive counseling in the epilepsy clinic and the likelihood that patients would obtain an IUD. METHODS We conducted a retrospective chart review of female patients age 18-45 seen at our institution for an initial visit between 2010 and 2014 to ascertain the type of contraceptive counseling each patient received as well as AED use and contraceptive methods. Patients who were pregnant or planning pregnancy at the first visit were excluded from further analyses as were patients with surgical sterilization. We also examined a subgroup of 95 patients with at least 4 follow-up visits to evaluate the efficacy of epileptologists' counseling. Specifically, we looked at the likelihood a patient obtained an IUD based on the type of counseling she had received. Fisher exact tests assessed associations between counseling type and whether patients had obtained an IUD. RESULTS Three hundred and ninety-seven women met criteria for inclusion. Only 35% of female patients were counseled about contraception at the first visit. If women were not counseled at the first visit, they were unlikely to be counseled at subsequent visits; only 37% had ever received counseling by their fourth visit. Of the 95 patients who completed 4 visits, 28.4% were counseled about an IUD as an optimal contraceptive choice, 38.9% were generally counseled about contraceptive interactions, and 32.6% were not counseled about contraception. Women with epilepsy who received IUD-specific counseling were significantly more likely to switch to an IUD (44.4%) compared with women who received no contraceptive counseling (6.5%; p=0.0009). Women with epilepsy who received IUD-specific counseling also tended to switch to an IUD more often than those women receiving general counseling about AEDs and contraceptive interactions (18.9%; p=0.027). There was no significant difference in the likelihood of acquiring an IUD between the general counseling and no counseling groups. CONCLUSIONS Contraceptive counseling by epileptologists and specific mention of an IUD is significantly associated with patient selection of an IUD as a contraceptive method. This suggests that neurologists can play an important role in patients' contraceptive choices.
Collapse
Affiliation(s)
- Alyssa R Espinera
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jay Gavvala
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Irena Bellinski
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey Kennedy
- Department of Neurology, University of California, Davis, CA, USA
| | - Micheal P Macken
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aditi Narechania
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica Templer
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephen VanHaerents
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephan U Schuele
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elizabeth E Gerard
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| |
Collapse
|
38
|
Suppression menstruelle en présence de circonstances particulières. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S484-S495. [DOI: 10.1016/j.jogc.2016.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
39
|
Gerard EE, Meador KJ. An Update on Maternal Use of Antiepileptic Medications in Pregnancy and Neurodevelopment Outcomes. J Pediatr Genet 2016; 4:94-110. [PMID: 27617120 DOI: 10.1055/s-0035-1556741] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Antiepileptic drugs (AEDs) are prescribed commonly to women of childbearing age. In utero exposure to some AEDs can have significant cognitive and behavioral consequences for the unborn child. Recently, prospective studies of women taking AEDs during pregnancy have added significantly to our understanding of cognitive and behavioral teratogenic risks posed by fetal AED exposure. Valproate is clearly associated with impaired cognitive development as well as an increased risk of disorders such as autism and autism spectrum disorder. Exposure to carbamazepine, lamotrigine, levetiracetam, or phenytoin monotherapy is associated with more favorable cognitive and behavioral outcomes than valproate, but more data are required to clarify if these AEDs have more subtle effects on cognition and behavior. There are insufficient data on the developmental effects of other AEDs in humans. Further, the underlying mechanisms of cognitive teratogenesis are poorly understood, including the genetic factors that affect susceptibility to AEDs.
Collapse
Affiliation(s)
- Elizabeth E Gerard
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, United States
| |
Collapse
|
40
|
Nephroprotective and antioxidant properties of Artemisia arborescens hydroalcoholic extract against oestroprogestative-induced kidney damages in rats. Biomed Pharmacother 2016; 82:520-7. [DOI: 10.1016/j.biopha.2016.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 12/11/2022] Open
|
41
|
Differential impact of contraceptive methods on seizures varies by antiepileptic drug category: Findings of the Epilepsy Birth Control Registry. Epilepsy Behav 2016; 60:112-117. [PMID: 27206228 DOI: 10.1016/j.yebeh.2016.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to determine whether categories of contraception differ in their impact on seizures in women with epilepsy and whether the impact varies by antiepileptic drug category. METHODS Retrospective survey data came from 2712 contraceptive experiences reported by 1144 women with epilepsy. We compared risk ratios for reports of increase and decrease in seizure frequency on hormonal versus nonhormonal contraception, stratified by antiepileptic drug categories. RESULTS More women with epilepsy reported a change in seizures on hormonal (28.2%) than on nonhormonal contraception (9.7%) (p<0.0001). The risk ratio for seizure increase on hormonal (18.7%) versus nonhormonal contraception (4.2%) was 4.47 (p<0.0001). The risk ratio for seizure decrease on hormonal (9.5%) versus nonhormonal contraception (5.5%) was 1.71, p<0.0001. On hormonal contraception, the risk ratio for seizure increase was greater than for decrease (1.98, p<0.0001). In comparison to combined pills, both hormonal patch and progestin-only pills had greater risk ratios for seizure increase. Depomedroxyprogesterone was the only hormonal method with a greater risk ratio for seizure decrease than combined pills. Seizure increase was greater for hormonal than nonhormonal contraception for each antiepileptic drug category (p<0.001). On hormonal contraception, relative to the non-enzyme-inducing antiepileptic drug category which had the lowest rate, each of the other categories had significantly greater risks for seizure increase, especially the enzyme-inhibiting (valproate) category (risk ratio=2.53, p=0.0002). CONCLUSION The findings provide community-based, epidemiological survey evidence that contraceptive methods may differ in their impact on seizures and that this impact may vary by antiepileptic drug category.
Collapse
|
42
|
|
43
|
Abstract
Approximately 50% of all pregnancies in women with epilepsy (WWE) occur unplanned. This is worrying, given the increased occurrence of obstetrical complications in WWE, including the risk of seizures and their possible consequences for both the mother and the unborn child. Hormonal contraception is usually regarded as highly effective, but it is subject to numerous bidirectional drug interactions with several antiepileptic drugs. These interactions may lead to loss of seizure control or contraceptive failure. Further concerns are loss of bone mineral density and increased seizure activity due to hormonal effects. Many physicians lack sufficient knowledge regarding these issues, and most WWE have never received adequate counseling. Moreover, several studies show that a large proportion of WWE do not take their medicines regularly. This article reviews all of these issues and offers practical recommendations for the management of contraception in WWE.
Collapse
Affiliation(s)
- Arne Reimers
- Department of Clinical Pharmacology, St Olavs University Hospital.,Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
44
|
Herzog AG, Mandle HB, Cahill KE, Fowler KM, Hauser WA, Davis AR. Contraceptive practices of women with epilepsy: Findings of the epilepsy birth control registry. Epilepsia 2016; 57:630-7. [DOI: 10.1111/epi.13320] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Andrew G. Herzog
- Harvard Neuroendocrine Unit; Beth Israel Deaconess Medical Center; Boston Massachusetts U.S.A
| | - Hannah B. Mandle
- Harvard Neuroendocrine Unit; Beth Israel Deaconess Medical Center; Boston Massachusetts U.S.A
| | - Kaitlyn E. Cahill
- Harvard Neuroendocrine Unit; Beth Israel Deaconess Medical Center; Boston Massachusetts U.S.A
| | - Kristen M. Fowler
- Harvard Neuroendocrine Unit; Beth Israel Deaconess Medical Center; Boston Massachusetts U.S.A
| | - W. Allen Hauser
- Gertrude H. Sergievsky Center; Mailman School of Public Health; Columbia University; New York New York U.S.A
| | - Anne R. Davis
- Department of OBGYN; Columbia University Medical Center; New York New York U.S.A
| |
Collapse
|
45
|
Long-acting reversible contraception in the pediatric emergency department: clinical implications and common challenges. Pediatr Emerg Care 2015; 31:286-92; quiz 293-5. [PMID: 25831033 DOI: 10.1097/pec.0000000000000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Long-acting reversible contraception (LARC) is recommended as first-line contraception for adolescents and young adults. As the use of LARC increases, pediatric emergency medicine clinicians should be able to recognize different types of LARC and address their common adverse effects, adverse reactions, and complications. This continuing medical education activity provides an overview of LARC and will assist clinicians in the evaluation and management of patients with LARC-associated complaints.
Collapse
|
46
|
Abstract
OBJECTIVE To provide a Canadian consensus document for health care providers with recommendations for menstrual suppression in patients with physical and/or cognitive challenges or those who are undergoing cancer treatment in whom menstruation may have a deleterious effect on their health. OPTIONS This document reviews the options available for menstrual suppression, its specific indications, contraindications, and side effects, both immediate and long-term, and the investigations and monitoring necessary throughout suppression. OUTCOMES Clinicians will be better informed about the options and indications for menstrual suppression in patients with cognitive and/or physical disabilities and patients undergoing chemotherapy, radiation, or other treatments for cancer. EVIDENCE Published literature was retrieved through searches of Medline, EMBASE, OVID, and the Cochrane Library using appropriate controlled vocabulary and key words (heavy menstrual bleeding, menstrual suppression, chemotherapy/radiation, cognitive disability, physical disability, learning disability). Results were restricted to systematic reviews, randomized controlled trials, observation studies, and pilot studies. There were no language or date restrictions. Searches were updated on a regular basis and new material was incorporated into the guideline until September 2013. Grey (unpublished) literature was identified through searching websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS There is a need for specific guidelines on menstrual suppression in at-risk populations for health care providers. Recommendations 1. Menstrual suppression and therapeutic amenorrhea should be considered safe and viable options for women who need or want to have fewer or no menses. (II-2A) 2. Menstrual suppression should not be initiated in young women with developmental disabilities until after the onset of menses. (II-2B) 3. Combined hormonal or progesterone-only products can be used in an extended or continuous manner to obtain menstrual suppression. (I-A) 4. Gynaecologic consultation should be considered prior to the initiation of treatment in all premenopausal women at risk for abnormal uterine bleeding from chemotherapy. (II-1A) 5. Leuprolide acetate or combined hormonal contraception should be considered highly effective in preventing abnormal uterine bleeding when initiated prior to cancer treatment in premenopausal women at risk for thrombocytopenia. (II-2A).
Collapse
|
47
|
Putta S, Pennell PB. Management of epilepsy during pregnancy: evidence-based strategies. FUTURE NEUROLOGY 2015; 10:161-176. [PMID: 30774557 DOI: 10.2217/fnl.15.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Child-bearing years are often the most precarious management period in the life of a woman with epilepsy. This article reviews the results of many different studies with findings that enable the healthcare team to make confident decisions and recommendations during these critical periods. Preconceptional planning, effective contraception and folic acid supplementation are important fundamentals in preparation for pregnancy. There is growing evidence to avoid valproic acid use during the child-bearing years. Emerging data on congenital malformations and neurocognitive outcomes are available for some of the second-generation antiepileptic drugs and appear reassuring for lamotrigine and levetiracetam. Also reviewed are the benefits of postpartum drug tapers and favorable breastfeeding facts. Counseling the mother and her family on medication choices enables the healthcare team to implement informed decisions that are beneficial for the mother and child.
Collapse
Affiliation(s)
- Swapna Putta
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Page B Pennell
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Division of Women's Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
48
|
Abstract
Contraception is a pillar in reducing adolescent pregnancy rates. The American Academy of Pediatrics recommends that pediatricians develop a working knowledge of contraception to help adolescents reduce risks of and negative health consequences related to unintended pregnancy. Over the past 10 years, a number of new contraceptive methods have become available to adolescents, newer guidance has been issued on existing contraceptive methods, and the evidence base for contraception for special populations (adolescents who have disabilities, are obese, are recipients of solid organ transplants, or are HIV infected) has expanded. The Academy has addressed contraception since 1980, and this policy statement updates the 2007 statement on contraception and adolescents. It provides the pediatrician with a description and rationale for best practices in counseling and prescribing contraception for adolescents. It is supported by an accompanying technical report.
Collapse
|
49
|
Abstract
A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.
Collapse
|
50
|
Ng CHM, Fraser IS, Berbic M. Contraception for women with medical disorders. Best Pract Res Clin Obstet Gynaecol 2014; 28:917-30. [PMID: 25087667 DOI: 10.1016/j.bpobgyn.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 11/29/2022]
Abstract
Many women in the reproductive years have chronic medical conditions that are affected by pregnancy or in which the fetus is placed at increased risk. In most of these women, ongoing medical management of their conditions is greatly improved, even compared with a decade or two ago. However, their condition may still be seriously exacerbated by the physiological changes of pregnancy, and close monitoring of a carefully planned pregnancy is optimal. This requires effective and safe contraceptive use until pregnancy is desired and the medical condition is stabilised. Many contraceptives will also have adverse effects on some medical conditions, and there is now a considerable awareness of the complexities of some of these interactions. For this reason the World Health Organization has developed an excellent, simple and pragmatic programme of guidelines on a four point scale (the WHO "Medical Eligibility Criteria": WHO-MEC), summarising risk of specific contraceptive methods in women with specified chronic medical conditions. The general approach to contraceptive management of many of these conditions is addressed in this article.
Collapse
Affiliation(s)
- Cecilia H M Ng
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia
| | - Ian S Fraser
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia.
| | - Marina Berbic
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia
| |
Collapse
|