1
|
Sargisian N, Petzold M, Furenäs E, Gissler M, Spangmose AL, Malchau Lauesgaard S, Opdahl S, Pinborg A, Henningsen AKA, Westvik-Johari K, Rönö K, Bergh C, Wennerholm UB. Congenital heart defects in children born after assisted reproductive technology: a CoNARTaS study. Eur Heart J 2024:ehae572. [PMID: 39326528 DOI: 10.1093/eurheartj/ehae572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/23/2024] [Accepted: 08/17/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND AND AIMS Children born after assisted reproductive technology (ART) have worse perinatal outcomes compared with spontaneously conceived children. This study investigates whether children conceived after ART have a higher risk of congenital heart defects (CHDs) compared with children born after spontaneous conception (SC). METHODS All 7 747 637 liveborn children in Denmark (1994-2014), Finland (1990-2014), Norway (1984-2015), and Sweden (1987-2015), where 171 735 children were conceived after ART, were included. National ART and medical birth registry data were cross-linked with data from other health and population registries. Outcomes were major CHDs, severe CHDs, 6 hierarchical CHD lesion groups, and 10 selected major CHDs, diagnosed prenatally or up to 1 year of age (Denmark, Finland, and Sweden) and prenatally or at birth (Norway). The association between ART and CHDs was assessed with multivariable logistic regression analysis, with adjustment for available confounders. RESULTS Major CHDs were detected in 3159 children born after ART (1.84%) and in 86 824 children born after SC [1.15%; adjusted odds ratio (AOR) 1.36; 95% confidence interval (CI) 1.31-1.41]. Risk was highest in multiples, regardless of conception method. Severe CHDs were detected in 594 children born after ART (0.35%) and in 19 375 children born after SC (0.26%; AOR 1.30; 95% CI 1.20-1.42). Risk was similar between ICSI and IVF and between frozen and fresh embryo transfer. CONCLUSIONS Assisted reproductive technology-conceived children have a higher prevalence of major CHDs, being rare, but severe conditions. The absolute risks are, however, modest and partly associated with multiple pregnancies, more prevalent in ART.
Collapse
Affiliation(s)
- Nona Sargisian
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Diagnosvägen 14, 416 85 Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Furenäs
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Center for Adults with Grown Up Congenital Heart Disease (ACHD/GUCH), Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Anne Lærke Spangmose
- Fertility Clinic, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sara Malchau Lauesgaard
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Diagnosvägen 14, 416 85 Gothenburg, Sweden
| | - Signe Opdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anja Pinborg
- Fertility Clinic, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna-Karina A Henningsen
- Fertility Clinic, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kjersti Westvik-Johari
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Fertility, Women and Children's Centre, St Olavs Hospital, Trondheim, Norway
| | - Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Christina Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Diagnosvägen 14, 416 85 Gothenburg, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Diagnosvägen 14, 416 85 Gothenburg, Sweden
| |
Collapse
|
2
|
Rasool M, Pushparaj PN, Haque A, Shorbaji AM, Mira LS, Bakhashab S, Alama MN, Farooq M, Karim S, Larsen LA. Discovery of a novel mutation F184S (c.551T>C) in GATA4 gene causing congenital heart disease in a consanguineous Saudi family. Heliyon 2024; 10:e37177. [PMID: 39286212 PMCID: PMC11403501 DOI: 10.1016/j.heliyon.2024.e37177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 08/25/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
Background & aim Congenital heart disease (CHD) is the most common cause of non-infectious deaths in infants worldwide. However, the molecular mechanisms underlying CHD remain unclear. Approximately 30 % of the causes are believed to be genetic mutations and chromosomal abnormalities. In this study, we aimed to identify the genetic causes of CHD in consanguineous families. Methods Fourth-generation pedigrees with CHD were recruited. The main cardiac features of the patient included absence of the right pulmonary artery and a large dilated left pulmonary artery. To determine the underlying genetic cause, whole-exome sequencing was performed and subsequently confirmed using Sanger sequencing and different online databases to study the pathogenesis of the identified gene mutation. An in-silico homology model was created using the Alphafold homology model structure of GATA4 (AF-P43694-F1). The missense3D online program was used to evaluate the structural alterations. Results We identified a deleterious mutation c.551T > C (p.Phe184Ser) in GATA4. GATA4 is a highly conserved zinc-finger transcription factor, and its continuous expression is essential for cardiogenesis during embryogenesis. The in-silico model suggested a compromised binding efficiency with other proteins. Several variant interpretation algorithms indicated that the F184S missense variant in GATA4 is damaging, whereas HOPE analysis indicated the functional impairment of DNA binding of transcription factors and zinc-ion binding activities of GATA4. Conclusion The variant identified in GATA4 appears to cause recessive CHD in the family. In silico analysis suggested that this variant was damaging and caused multiple structural and functional aberrations. This study may support prenatal screening of the fetus in this family to prevent diseases in new generations.
Collapse
Affiliation(s)
- Mahmood Rasool
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Peter Natesan Pushparaj
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Absarul Haque
- King Fahd Medical Research Center, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ayat Mohammed Shorbaji
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Loubna Siraj Mira
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherin Bakhashab
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Nabil Alama
- Department of Cardiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Muhammad Farooq
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Sajjad Karim
- Center of Excellence in Genomic Medicine Research, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lars Allan Larsen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Denmark
| |
Collapse
|
3
|
Fabiano N, Wong S, Gupta A, Tran J, Bhambra N, Min KK, Dragioti E, Barbui C, Fiedorowicz JG, Gosling CJ, Cortese S, Gandhi J, Saraf G, Shorr R, Vigod SN, Frey BN, Delorme R, Solmi M. Safety of psychotropic medications in pregnancy: an umbrella review. Mol Psychiatry 2024:10.1038/s41380-024-02697-0. [PMID: 39266712 DOI: 10.1038/s41380-024-02697-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 09/14/2024]
Abstract
Weighing risks and benefits of the use of psychotropic medications during pregnancy remains a challenge worldwide. We systematically assessed the strength of associations between psychotropic medication use in pregnant people with mental disorders and various adverse health outcomes in both pregnant people and foetuses. Systematic reviews with meta-analyses of observational studies investigating the association between exposure to psychotropic medication in pregnancy and any adverse health outcomes were included. Credibility was graded into convincing, highly suggestive, suggestive, weak or not significant. Quality of the meta-analyses and of individual studies were assessed with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) the Newcastle-Ottawa Scale (NOS), respectively. We considered 21 meta-analyses encompassing 17,290,755 participants (AMSTAR 2 high = 1, low = 12, or critically low = 8). Evidence was suggestive for: (1) preterm birth in pregnant people with either any mental disorder (equivalent odds ratio 1.62 (95% confidence interval 1.24-2.12) or depression (1.65 [1.34-2.02]) receiving antidepressants during any trimester of pregnancy; (2) small for gestational age for pregnant people with depression receiving a SSRI during any trimester of pregnancy (1.50 [1.19-1.90]); and (3) major congenital malformation (1.24 [1.09-1.40]) or cardiac malformations (1.28 [1.11-1.47]) in babies for pregnant people with depression or anxiety receiving paroxetine during first trimester of pregnancy. Additional associations were supported by weak evidence, or were not statistically significant. This umbrella review found no convincing or highly suggestive level of evidence of adverse health outcomes associated with psychotropic medication use in pregnant people with mental disorders.
Collapse
Affiliation(s)
- Nicholas Fabiano
- SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Stanley Wong
- SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arnav Gupta
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- College of Public Health, Kent State University, Kent, OH, US
| | - Jason Tran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nishaant Bhambra
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin K Min
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Corentin J Gosling
- DysCo Laboratory, Université Paris Nanterre, F9200, Nanterre, France
- Laboratory of Psychopathology and Health Process, Université Paris Cité, F92000, Paris, France
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Jasmine Gandhi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Risa Shorr
- Library Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's, College Hospital and University of Toronto, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, University of Paris Cité, Paris, France
| | - Marco Solmi
- SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada.
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
| |
Collapse
|
4
|
Bellas L, Camacho-Arteaga L, Giner-Soriano M, Prats-Uribe A, Aguilera C, Vedia Urgell C, Agustí A. Women's health in focus: Real-world data on valproate prescriptions during pregnancy - a cohort study in Catalonia (Spain). BMJ Open 2024; 14:e085167. [PMID: 39134441 PMCID: PMC11337672 DOI: 10.1136/bmjopen-2024-085167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVES To characterise the exposure to valproate within a cohort of pregnant women using electronic health records (EHRs) from Catalonia (System for the Development of Research in Primary Care, SIDIAP). DESIGN Drug-utilisation cohort study covering the period from January 2011 to June 2020. The study included pregnancy episodes of women from Catalonia identified by the algorithm. SETTING Data were sourced from SIDIAP, a comprehensive EHR repository that includes information from various data sources: recorded prescriptions (both hospital and primary care), diagnoses and sociodemographic characteristics identified by primary care physicians, and sexual and reproductive health data from ASSIR (used by gynaecologists and midwives). PARTICIPANTS Women aged 12-50 with at least one pregnancy episode occurred during January 2011-June 2020 and at least a prescription of valproate during pregnancy. PRIMARY AND SECONDARY OUTCOMES Primary outcomes included valproate exposure, measured through prevalence and cumulative incidence in pregnancy episodes and by trimester. The impact of regulatory measures (risk mitigation measures, RMMs) was assessed, and prescriptions over time were analysed using interrupted time series analysis. Secondary outcomes included health issues, pregnancy outcomes, smoking habits and socioeconomic characteristics. RESULTS A total of 99 605 pregnancies were identified, with at least 3.03‰ (95% CI 2.69‰ to 3.39‰) exposed to valproate at some point (302 pregnancies, 276 women). The median pregnancy duration was 38.30 weeks (IQR 12.6-40.1), and the median age at pregnancy was 32.37 years (IQR 27.20-36.56). Epilepsy was the most frequent health issue. The prevalence and cumulative incidence of valproate prescriptions decreased during pregnancy and increased postpregnancy. The RMMs implemented in 2014 led to a reduction in monthly valproate prescriptions during pregnancy in this cohort. CONCLUSIONS The study highlights the decline in valproate prescriptions during pregnancy due to RMMs and underscores the need for standardised methodologies in future studies to ensure the safety of pregnant patients and optimise scientific evidence.
Collapse
Affiliation(s)
- Lucía Bellas
- Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Lina Camacho-Arteaga
- Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Maria Giner-Soriano
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Albert Prats-Uribe
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Cristina Aguilera
- Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Cristina Vedia Urgell
- Unitat de farmàcia. Servei d’Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Spain
- Departament de Farmacologia i Terapèutica, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Antonia Agustí
- Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autonòma de Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Smolinski NE, Sarayani A, Thai TN, Jugl S, Ewig CLY, Winterstein AG. Prenatal Exposure to Valproic Acid Across Various Indications for Use. JAMA Netw Open 2024; 7:e2412680. [PMID: 38776082 PMCID: PMC11112441 DOI: 10.1001/jamanetworkopen.2024.12680] [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: 11/03/2023] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Teratogenic outcomes associated with valproic acid use represent a substantial concern for persons of childbearing age. Regulatory agencies worldwide have enhanced warnings or implemented risk minimization programs to reduce exposure during pregnancy. Objectives To determine pregnancy rates during valproic acid use and concomitant contraception use across indications. Design, Setting, and Participants This retrospective cohort study used data from the Merative MarketScan commercial claims databases from January 1, 2005, to December 31, 2020, to identify female patients aged 12 to 44 years who initiated valproic acid treatment and had continuous insurance enrollment 6 months before initiation and 9 months after treatment end. A treatment episode included consecutive prescription fills that occurred within 7 days from the end of the days' supply of the previous dispensing. Data were analyzed from March 1 to September 10, 2023. Main Outcomes and Measures Treatment episodes were categorized by inferred indication using diagnoses preceding treatment initiation, including epilepsy, migraine or headache, mood disorders, and unknown or off-label uses. Pregnancy incidence rate ratios (IRRs) were calculated and were adjusted for age and calendar year. Contraceptive use (prescription contraceptives, intrauterine devices, and implants) during treatment was examined. Results The cohort included 165 772 valproic acid treatment episodes among 69 390 women (mean [SD] age, 29.8 [10.0] years). Mood disorders (42.5%) were the most common indication, followed by migraine or headache (20.1%), with epilepsy playing a minor role (14.9%). Pregnancy incidence rates during valproic acid use remained unchanged, with a rate of 1.74 (95% CI, 1.14-2.53) per 100 person-years in 2005 and a rate of 1.90 (95% CI, 1.16-3.12) per 100 person-years in 2019. Compared with epilepsy, pregnancy rates were more than double for mood disorder (IRR, 2.16 [95% CI, 1.93-2.42]) and migraine or headache (IRR, 2.01 [95% CI, 1.92-2.09]). Few treatment episodes coincided with contraceptive use (37 012 [22.3%]), and oral dosage forms were the most common (27 069 [73.1%]). Conclusions and Relevance In this cohort study of patients of childbearing age who used valproic acid, pregnancy rates during valproic acid use did not decrease despite enhanced US Food and Drug Administration safety communications, and contraception use remained low. Patients with migraine and mood disorders accounted for the largest proportion of valproic acid use and had the highest pregnancy rates, while patients with epilepsy had the lowest. These findings suggest a need to enhance efforts to mitigate prenatal exposure to valproic acid, especially for indications where the risk of use during pregnancy outweighs the benefit.
Collapse
Affiliation(s)
- Nicole E. Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
| | - Amir Sarayani
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Now with Janssen Research & Development, LLC, Raritan, New Jersey
| | - Thuy N. Thai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Faculty of Pharmacy, HUTECH University (Ho Chi Minh City University of Technology), Ho Chi Minh City, Vietnam
| | - Sebastian Jugl
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
| | - Celeste L. Y. Ewig
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville
| |
Collapse
|
6
|
Honybun E, Cockle E, Malpas CB, O'Brien TJ, Vajda FJ, Perucca P, Rayner G. Neurodevelopmental and Functional Outcomes Following In Utero Exposure to Antiseizure Medication: A Systematic Review. Neurology 2024; 102:e209175. [PMID: 38531021 DOI: 10.1212/wnl.0000000000209175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/04/2023] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To undertake a systematic review of the available literature to examine the relationship between prenatal antiseizure medication (ASM) exposure and adverse postnatal neurodevelopmental outcomes, focusing on social, emotional, behavioral, and adaptive domains of human function, and the frequency of neurodevelopmental and psychiatric disorders in ASM-exposed offspring. METHODS Electronic searches of MEDLINE, PsychINFO, and EMBASE were conducted and limited to studies published between 1990 and 2023 in English. Studies were eligible if they prospectively or retrospectively reported neurodevelopmental outcomes of ASM-exposed offspring. The Newcastle-Ottawa scale was used to conduct methodologic quality assessments of included studies, and a narrative synthesis integrated the review findings. RESULTS Forty-three studies were included. Valproate has been consistently associated with a 2- to 4-fold increased risk of autism spectrum disorder (ASD), 2- to 5-fold increased risk of intellectual disability (ID), and poor adaptive functioning. Growing evidence indicates that topiramate is associated with a 2-fold increased risk of ASD and 3- to 4-fold increased risk of ID. The risks of adverse neurodevelopmental outcomes for valproate and topiramate seem to be dose dependent. Phenobarbital has been suggested to be associated with deleterious neurodevelopmental effects, but data are limited. Levetiracetam has recently been linked with an increased risk of attention deficit hyperactivity disorder and anxiety disorders in a single study. Carbamazepine has been associated with variable neurodevelopmental outcomes. Lamotrigine seems to be "safe" in terms of postnatal neurodevelopment. Data for oxcarbazepine, phenytoin, and clonazepam are limited but seem to have little-to-no risk of adverse outcomes. Evidence for the remaining ASMs, including gabapentin, pregabalin, lacosamide, zonisamide, clobazam, perampanel, ethosuximide, or brivaracetam, is lacking. Several methodologic limitations impeded data synthesis, including heterogeneity in outcome measures and small samples of monotherapy exposures. DISCUSSION The findings of this review support the conclusion that valproate and topiramate use during pregnancy is associated with a significantly increased risk of neurodevelopmental effects on the fetus. Apart from lamotrigine, which seems to be free of adverse neurodevelopmental effects, data for the other ASMs are mixed or inadequate to draw definite conclusions. Further research into the neurodevelopmental effects of prenatal exposure to ASMs, including most newer agents, is much needed.
Collapse
Affiliation(s)
- Eliza Honybun
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Emily Cockle
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Charles B Malpas
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Terence J O'Brien
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Frank J Vajda
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Piero Perucca
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Genevieve Rayner
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| |
Collapse
|
7
|
Li Z, Zhao X, Zhang G, Xi C, Yang L. Efficacy of levetiracetam combined with oxcarbazepine in the treatment of adults with temporal lobe epilepsy and its impact on memory and cognitive function. Am J Transl Res 2024; 16:1009-1017. [PMID: 38586112 PMCID: PMC10994801 DOI: 10.62347/knte8578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To explore the effect of levetiracetam combined with oxcarbazepine on the memory and cognitive function of adult patients with temporal lobe epilepsy. METHODS This retrospective analysis included 91 adult patients with temporal lobe epilepsy treated at Xianyang Hospital from June 2020 to December 2022. Based on their medication regimen, patients were categorized into an observation group (n=51) receiving levetiracetam plus oxcarbazepine and a control group (n=40) receiving only levetiracetam. Both groups underwent 3 months of continuous treatment. Therapeutic efficacy, pre- and post-treatment memory function (assessed using the Clinical Memory Scale, CMS), cognitive function (evaluated with the Wechsler Adult Intelligence Scale-Revised in China, WAISRC), anxiety and depression levels (measured by the Hamilton Anxiety Scale, HAMA, and Hamilton Depression Scale, HAMD), as well as adverse reactions, were compared between the two groups. Independent factors influencing treatment efficacy were also analyzed. RESULTS CMS and WAISRC scores significantly increased in both groups after treatment (both P=0.001), with the observation group showing more significant improvements than the control group (P=0.001). The improvements in HAMA and HAMD scores in the observation group were significantly better than the control group (all P<0.001). Adverse reaction occurrence showed no significant difference between the two groups (P>0.05). Prognostic analysis identified seizure frequency and treatment regimen as independent factors influencing efficacy. CONCLUSION Levetiracetam combined with oxcarbazepine effectively improves cognitive dysfunction in adults with temporal lobe epilepsy, with superior efficacy to levetiracetam alone, and good safety.
Collapse
Affiliation(s)
- Zhangxia Li
- Ward 15, Department of Neurology, Xianyang Hospital, Yan’an UniversityXianyang 712000, Shaanxi, China
| | - Xiongfei Zhao
- Ward 15, Department of Neurology, Xianyang Hospital, Yan’an UniversityXianyang 712000, Shaanxi, China
| | - Guoxun Zhang
- Ward 15, Department of Neurology, Xianyang Hospital, Yan’an UniversityXianyang 712000, Shaanxi, China
| | - Cong Xi
- Department of Neurology, Baoji City People’s HospitalBaoji 721001, Shaanxi, China
| | - Liying Yang
- Department of Neurology, Baoji City People’s HospitalBaoji 721001, Shaanxi, China
| |
Collapse
|
8
|
Guldberg F, Larsen CC, Østergaard E, Carlsen J, Juhler M, Munch TN. Prenatal dispositions and genetic analysis of monozygotic female twins with suprasellar cysts and hydrocephalus: A case report. Childs Nerv Syst 2024; 40:947-951. [PMID: 38052889 PMCID: PMC10891213 DOI: 10.1007/s00381-023-06245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION We present a unique case of monozygotic female twins with virtually identical clinical and radiological presentations of supratentorial hydrocephalus and cystic formations from the suprasellar cistern. DISCUSSION Evaluating genetic predispositions and prenatal exposures is crucial for hydrocephalus in twins. Familial cases imply a genetic contribution to the development of these anomalies, including chromosomal abnormalities and specific variants linked to arachnoid cyst formation in various syndromes. Extensive genetic analyses found no pathogenic variants in the twins. Prenatal exposure to anti-epileptic medication was known during pregnancy and may be associated with fetal abnormalities, but not central nervous system (CNS) malformations, and was therefore not considered the cause of the condition in the twins. The twins presenting simultaneously with hydrocephalus caused by suprasellar cysts (SAC) underwent a two-step surgical management: initial ventriculoperitoneal shunt (VPS) placement followed by fenestration. Postoperative imaging showed cyst reduction, but a secondary VPS was necessary in both cases. CONCLUSION Genetic analysis is less likely to identify a monogenic etiology in non-syndromic cases of SACs, which are assumed to be multifactorial. There is no established evidence linking a teratogenic effect of anti-epileptic drugs to CNS malformations. Moreover, the surgical treatment of this complex condition constitutes a point of discussion.
Collapse
Affiliation(s)
- Frederikke Guldberg
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Elsebet Østergaard
- Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Carlsen
- Department of Radiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| |
Collapse
|
9
|
Vukovic-Cvetkovic V, Beier D, Buchgreitz L, Korsbaek JJ, Jensen RH. Management and Outcome of Pregnancy in Patients With Idiopathic Intracranial Hypertension: A Prospective Case Series Study. Neurol Clin Pract 2024; 14:e200226. [PMID: 38213400 PMCID: PMC10781565 DOI: 10.1212/cpj.0000000000200226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/10/2023] [Indexed: 01/13/2024]
Abstract
Background and Objectives Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure without an identifiable cause that mostly affects obese persons of childbearing age. In this prospective case series, we have evaluated the overall outcome of pregnancy and birth in participants with IIH and their newborn children. We also provide a proposal for the management of pregnant persons with IIH. Methods In this observational study, neuro-ophthalmological findings, the course of IIH-related symptoms, disease management, and pregnancy outcomes were evaluated. The participants were divided into 3 groups according to the course of the disease during pregnancy: stable, worsened, and new diagnosed. Furthermore, the type of delivery and outcome of newborn children such as gestational age, weight at birth, and the presence of asphyxia were compared between the groups. Results We observed 47 pregnancies in 42 participants; 2 had spontaneous abortions. There were 19 (47%) participants in the stable, 18 (45%) in the worsened, and 3 (8%) in the new diagnosed groups, respectively. A relapse of IIH occurred in 2 (5%). Worsening of IIH-related symptoms was experienced by 18/37 (49%) participants: headache by 17/18 (94%), tinnitus by 11/18 (61%), and vision by 7/18 (39%) (mostly in the first and second trimester). In 8/18 (44%), the symptoms were transient or alleviated in the second and third trimester. Body mass index before and after pregnancy did not significantly differ among the groups. A total of 8 participants were treated with acetazolamide. The frequency of cesarean section was 17/40 (43%). Preterm delivery occurred in 22%. No increased risk of asphyxia was observed, and all infants, but one, were healthy. Discussion Worsening of headache, tinnitus, and/or vision were experienced by half of pregnant participants with IIH, mostly transient in the first and second trimester, rarely required specific treatment, and were not identified as a relapse of IIH. There was no difference in gestational age and weight at birth in children among the groups, and no perinatal asphyxia was noted. Weight gain in the participants was not identified as a risk factor for relapse of IIH in pregnancy. The rate of cesarean and preterm delivery was higher than in the non-IIH population. A proposal for the management of IIH in pregnancy is provided.
Collapse
Affiliation(s)
- Vlasta Vukovic-Cvetkovic
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| | - Dagmar Beier
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| | - Line Buchgreitz
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| | - Johanne J Korsbaek
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| | - Rigmor H Jensen
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| |
Collapse
|
10
|
Cohen JM, Alvestad S, Suarez EA, Schaffer A, Selmer RM, Havard A, Bateman BT, Cesta CE, Zoega H, Odsbu I, Huybrechts KF, Kjerpeseth LJ, Straub L, Leinonen MK, Bjørk MH, Nørgaard M, Gissler M, Ulrichsen SP, Hernandez-Diaz S, Tomson T, Furu K. Comparative Risk of Major Congenital Malformations With Antiseizure Medication Combinations vs Valproate Monotherapy in Pregnancy. Neurology 2024; 102:e207996. [PMID: 38165339 PMCID: PMC10870741 DOI: 10.1212/wnl.0000000000207996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Valproate should be avoided in pregnancy, but it is the most effective drug for generalized epilepsies. Alternative treatment may require combinations of other drugs. Our objectives were to describe first trimester use of antiseizure medication (ASM) combinations that are relevant alternatives to valproate and determine whether specific combinations were associated with a lower risk of major congenital malformations (MCM) compared with valproate monotherapy. METHODS We conducted a population-based cohort study using linked national registers from Denmark, Finland, Iceland, Norway, and Sweden and administrative health care data from the United States and New South Wales, Australia. We described first trimester use of ASM combinations among pregnant people with epilepsy from 2000 to 2020. We compared the risk of MCM after first trimester exposure to ASM combinations vs valproate monotherapy and low-dose valproate plus lamotrigine or levetiracetam vs high-dose valproate (≥1,000 mg/d). We used log-binomial regression with propensity score weights to calculate adjusted risk ratios (aRRs) and 95% CIs for each dataset. Results were pooled using fixed-effects meta-analysis. RESULTS Among 50,905 pregnancies in people with epilepsy identified from 7.8 million total pregnancies, 788 used lamotrigine and levetiracetam, 291 used lamotrigine and topiramate, 208 used levetiracetam and topiramate, 80 used lamotrigine and zonisamide, and 91 used levetiracetam and zonisamide. After excluding pregnancies with use of other ASMs, known teratogens, or a child diagnosed with MCM of infectious or genetic cause, we compared 587 exposed to lamotrigine-levetiracetam duotherapy and 186 exposed to lamotrigine-topiramate duotherapy with 1959 exposed to valproate monotherapy. Pooled aRRs were 0.41 (95% CI 0.24-0.69) and 1.26 (0.71-2.23), respectively. Duotherapy combinations containing low-dose valproate were infrequent, and comparisons with high-dose valproate monotherapy were inconclusive but suggested a lower risk for combination therapy. Other combinations were too rare for comparative safety analyses. DISCUSSION Lamotrigine-levetiracetam duotherapy in first trimester was associated with a 60% lower risk of MCM than valproate monotherapy, while lamotrigine-topiramate was not associated with a reduced risk. Duotherapy with lamotrigine and levetiracetam may be favored to treat epilepsy in people with childbearing potential compared with valproate regarding MCM, but whether this combination is as effective as valproate remains to be determined. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in people with epilepsy treated in the first trimester of pregnancy, the risk of major congenital malformations is lower with lamotrigine-levetiracetam duotherapy than with valproate alone, but similar with lamotrigine-topiramate.
Collapse
Affiliation(s)
- Jacqueline M Cohen
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Silje Alvestad
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth A Suarez
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Andrea Schaffer
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Randi M Selmer
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Alys Havard
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Brian T Bateman
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Carolyn E Cesta
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Helga Zoega
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Ingvild Odsbu
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Krista F Huybrechts
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Lars J Kjerpeseth
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Loreen Straub
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Maarit K Leinonen
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Marte-Helene Bjørk
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Mette Nørgaard
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Sinna P Ulrichsen
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Sonia Hernandez-Diaz
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Tomson
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Kari Furu
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
11
|
Calado AM, Seixas F, Pires MDA. Updating an Overview of Teratology. Methods Mol Biol 2024; 2753:1-38. [PMID: 38285332 DOI: 10.1007/978-1-0716-3625-1_1] [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: 01/30/2024]
Abstract
In this chapter, the authors aim to update an overview of the principles of teratology, beginning with the definition of teratology, the critical point at which this process occurs, and some of the most common etiological agents that improve our understanding of teratology.Modern teratology has greatly improved in recent years with advances in new methods in molecular biology, toxicology, animal laboratory science, and genetics, increasing our knowledge of ambient influences. Nevertheless, there is a lot to do to reduce the influence of hazardous intervening agents, whether they target our genetics or not, that can negatively affect pregnancy and induce congenital development disorders, including morphological, biochemical, or behavioral defects.Certain agents might indeed be related to certain defects, but we have not been able to identify the cause of most congenital defects, which highlights the importance of finding and testing out new genetics techniques and conducting laboratory animal science to unravel the etiology and pathogenicity of each congenital defect.
Collapse
Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
| |
Collapse
|
12
|
Tsai DHT, Bell JS, Abtahi S, Baak BN, Bazelier MT, Brauer R, Chan AYL, Chan EW, Chen H, Chui CSL, Cook S, Crystal S, Gandhi P, Hartikainen S, Ho FK, Hsu ST, Ilomäki J, Kim JH, Klungel OH, Koponen M, Lau WCY, Lau KK, Lum TYS, Luo H, Man KKC, Pell JP, Setoguchi S, Shao SC, Shen CY, Shin JY, Souverein PC, Tolppanen AM, Wei L, Wong ICK, Lai ECC. Cross-Regional Data Initiative for the Assessment and Development of Treatment for Neurological and Mental Disorders. Clin Epidemiol 2023; 15:1241-1252. [PMID: 38146486 PMCID: PMC10749544 DOI: 10.2147/clep.s426485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/04/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose To describe and categorize detailed components of databases in the Neurological and Mental Health Global Epidemiology Network (NeuroGEN). Methods An online 132-item questionnaire was sent to key researchers and data custodians of NeuroGEN in North America, Europe, Asia and Oceania. From the responses, we assessed data characteristics including population coverage, data follow-up, clinical information, validity of diagnoses, medication use and data latency. We also evaluated the possibility of conversion into a common data model (CDM) to implement a federated network approach. Moreover, we used radar charts to visualize the data capacity assessments, based on different perspectives. Results The results indicated that the 15 databases covered approximately 320 million individuals, included in 7 nationwide claims databases from Australia, Finland, South Korea, Taiwan and the US, 6 population-based electronic health record databases from Hong Kong, Scotland, Taiwan, the Netherlands and the UK, and 2 biomedical databases from Taiwan and the UK. Conclusion The 15 databases showed good potential for a federated network approach using a common data model. Our study provided publicly accessible information on these databases for those seeking to employ real-world data to facilitate current assessment and future development of treatments for neurological and mental disorders.
Collapse
Affiliation(s)
- Daniel Hsiang-Te Tsai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Centre for Neonatal and Paediatric Infection, St George’s University of London, London, UK
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Brenda N Baak
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Marloes T Bazelier
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Adrienne Y L Chan
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, ‐Epidemiology and ‐Economics, University of Groningen, Groningen, the Netherlands
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Esther W Chan
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Department of Pharmacy, the University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, People’s Republic of China
| | - Haoqian Chen
- Center for Pharmacoepidemiology and Treatment Science (PETS), Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Sharon Cook
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Poonam Gandhi
- Center for Pharmacoepidemiology and Treatment Science (PETS), Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Shao-Ti Hsu
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Wallis C Y Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Terry Y S Lum
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Hao Luo
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Soko Setoguchi
- Center for Pharmacoepidemiology and Treatment Science (PETS), Institute for Health, Rutgers University, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School and Pharmacoepidemiology and Treatments Science, Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Yao Shen
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Seoul, South Korea
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
- Aston Pharmacy School, Aston University, Birmingham, UK
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
13
|
Lee SK. Issues of Women with Epilepsy and Suitable Antiseizure Drugs. J Epilepsy Res 2023; 13:23-35. [PMID: 38223363 PMCID: PMC10783964 DOI: 10.14581/jer.23005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024] Open
Abstract
Seizure aggravation in women with epilepsy (WWE) tends to occur at two specific times during the menstrual cycle: the perimenstrual phase and the ovulation period. Antiseizure drugs (ASDs), especially those that induce enzymes, can accelerate the metabolism of hormones in oral contraceptives, rendering them less effective. Estrogen in contraceptive pills increases the metabolism of lamotrigine. Physiological changes during pregnancy can significantly impact the pharmacokinetics of ASDs, potentially necessitating adjustments in dosage for women with epilepsy to maintain seizure control. The use of valproate in pregnant women is associated with the highest risk of major congenital malformations among ASDs. Risks of major congenital malformations associated with lamotrigine, levetiracetam, and oxcarbazepine were within the range reported in the general population. Exposure to valproate can lead to lower IQ in offspring. Reduced folic acid levels are linked to orofacial clefts, cardiovascular malformations, and urogenital and limb anomalies in WWE. Decreased folate levels are expected with the use of enzyme-inducing ASDs. However, a high dose of folate was associated with an increased risk of cancer in children of mothers with epilepsy. Most ASDs are generally considered safe for breastfeeding and should be encouraged. However, no single ASD is considered ideal for childbearing WWE. Lamotrigine and levetiracetam are relatively more suitable options for this situation.
Collapse
Affiliation(s)
- Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Dono F, Consoli S, Tappatà M, Evangelista G, Russo M, Lanzone J, Pozzilli V, Nucera B, Rinaldi F, Di Pietro M, Tinti L, Troisi S, Calisi D, D'Apolito M, Narducci F, Assenza G, Anzellotti F, Brigo F, Vollono C, Onofrj M, Sensi SL, Michelucci R. Autoimmune encephalitis during pregnancy: A diagnostic and therapeutic challenge-A systematic review with individual patients' analysis and clinical recommendations. Epilepsia Open 2023; 8:1221-1240. [PMID: 37562964 PMCID: PMC10690706 DOI: 10.1002/epi4.12806] [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] [Received: 05/25/2023] [Accepted: 08/06/2023] [Indexed: 08/12/2023] Open
Abstract
Several reports have described the autoimmune encephalitis' (AE) possible onset during pregnancy. In this systematic review, we summarize the available data on the diagnostic and therapeutic approach to AE during pregnancy, highlighting the associated maternal and fetal clinical outcomes. A systematic search of the literature was performed. The following databases were used: PubMed, Google Scholar, EMBASE, and CrossRef. The revision was registered on the PROSPERO platform (CRD42022336357). Forty-nine patients were included. AE onset was mainly observed during the first and the second trimester of pregnancy with psychiatric manifestations and seizures as main onset symptoms. CSF analysis showed AE-specific autoantibody positivity in 33 patients (anti-NMDA receptor as the most frequent). EEG generally showed normal findings. MRI revealed pathological findings in less than half of patients. Tumor screening was positive in 14 cases. First-line immunotherapy (single or combined) was generally employed while second line was administered in a minority of patients. Levetiracetam was the most used antiseizure medication. Cesarean section was performed in 18 women. Most of the women had an excellent early outcome after delivery but 22 showed persistent neurological deficits in long-term follow-up. Fetal outcome was positive in 33 cases, whereas 12 cases of fetal death were reported. A logistic regression showed that no variable significantly influenced the odds of good/bad maternal and fetal clinical outcome. Diagnosis and treatment of AE during pregnancy is challenging. The rate of miscarriage in women with AE seems to be higher than the general population. In addition, mothers may show long-term neurological deficits.
Collapse
Affiliation(s)
- Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Maria Tappatà
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Jacopo Lanzone
- Neurorehabilitation Department, IRCCS Salvatore Maugeri FoundationInstitute of MilanMilanItaly
- Department of Systems Medicine, NeuroscienceUniversity of Rome Tor VergataRomeItaly
| | - Valeria Pozzilli
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Bruna Nucera
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Fabrizio Rinaldi
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Lorenzo Tinti
- Department of NeurologySan Gerardo Hospital ASST MonzaMonzaItaly
| | - Serena Troisi
- Pediatric Neurology, Department of NeuroscienceSantobono‐Pausilipon Children's HospitalNaplesItaly
| | - Dario Calisi
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Maria D'Apolito
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of MedicineUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of MedicineUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Francesca Anzellotti
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Francesco Brigo
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Catello Vollono
- Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences and OrthopedicsIRCCS Policlinico Universitario Agostino Gemelli, Catholic UniversityRomeItaly
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Stefano L. Sensi
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | | |
Collapse
|
15
|
Fawcett J, Davis S, Manford M. Further advances in epilepsy. J Neurol 2023; 270:5655-5670. [PMID: 37458794 DOI: 10.1007/s00415-023-11860-6] [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] [Received: 05/31/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 10/15/2023]
Abstract
In 2017, one of us reviewed advances in epilepsy (Manford in J Neurol 264:1811-1824, 2017). The current paper brings that review up to date and gives a slight change in emphasis. Once again, the story is of evolution rather than revolution. In recognition that most of our current medications act on neurotransmitters or ion channels, and not on the underlying changes in connectivity and pathways, they have been renamed as antiseizure (ASM) medications rather than antiepileptic drugs. Cenobamate is the one newly licensed medication for broader use in focal epilepsy but there have been a number of developments for specific disorders. We review new players and look forward to new developments in the light of evolving underlying science. We look at teratogenicity; old villains and new concerns in which clinicians play a vital role in explaining and balancing the risks. Medical treatment of status epilepticus, long without evidence, has benefitted from high-quality trials to inform practice; like buses, several arriving at once. Surgical treatment continues to be refined with improvements in the pre-surgical evaluation of patients, especially with new imaging techniques. Alternatives including stereotactic radiotherapy have received further focus and targets for palliative stimulation techniques have grown in number. Individuals' autonomy and quality of life continue to be the subject of research with refinement of what clinicians can do to help persons with epilepsy (PWE) achieve control. This includes seizure management but extends to broader considerations of human empowerment, needs and desires, which may be aided by emerging technologies such as seizure detection devices. The role of specialist nurses in improving that quality has been reinforced by specific endorsement from the International League against Epilepsy (ILAE).
Collapse
Affiliation(s)
- Joanna Fawcett
- Department of Neurology, Royal United Hospital, Bath, UK
| | - Sarah Davis
- Department of Neurology, Royal United Hospital, Bath, UK
| | - Mark Manford
- Department of Neurology, Royal United Hospital, Bath, UK.
| |
Collapse
|
16
|
Gunasekera CL, Sirven JI, Feyissa AM. The evolution of antiseizure medication therapy selection in adults: Is artificial intelligence -assisted antiseizure medication selection ready for prime time? J Cent Nerv Syst Dis 2023; 15:11795735231209209. [PMID: 37868934 PMCID: PMC10586013 DOI: 10.1177/11795735231209209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Antiseizure medications (ASMs) are the mainstay of symptomatic epilepsy treatment. The primary goal of pharmacotherapy with ASMs in epilepsy is to achieve complete seizure remission while minimizing therapy-related adverse events. Over the years, more ASMs have been introduced, with approximately 30 now in everyday use. With such a wide variety, much guidance is needed in choosing ASMs for initial therapy, subsequent replacement monotherapy, or adjunctive therapy. The specific ASMs are typically tailored by the patient's related factors, including epilepsy syndrome, age, sex, comorbidities, and ASM characteristics, including the spectrum of efficacy, pharmacokinetic properties, safety, and tolerability. Weighing these key clinical variables requires experience and expertise that may be limited. Furthermore, with this approach, patients may endure multiple trials of ineffective treatments before the most appropriate ASM is found. A more reliable way to predict response to different ASMs is needed so that the most effective and tolerated ASM can be selected. Soon, alternative approaches, such as deep machine learning (ML), could aid the individualized selection of the first and subsequent ASMs. The recognition of epilepsy as a network disorder and the integration of personalized epilepsy networks in future ML platforms can also facilitate the prediction of ASM response. Augmenting the conventional approach with artificial intelligence (AI) opens the door to personalized pharmacotherapy in epilepsy. However, more work is needed before these models are ready for primetime clinical practice.
Collapse
|
17
|
[Guidelines for the management of adverse effects of anti-seizure medications (2023)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:889-900. [PMID: 37718393 PMCID: PMC10511233 DOI: 10.7499/j.issn.1008-8830.2306016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/28/2023] [Indexed: 09/19/2023]
Abstract
Epilepsy is a prevalent neurological disorder with a complex etiology and an unclear pathogenesis. In order to standardize the management of adverse effects caused by anti-seizure medications (ASMs), the Youth Committee of the Chinese Association Against Epilepsy (CAAE), in collaboration with the CAAE Precision Medicines and Adverse Effect Monitoring Committee, has developed a guideline: guidelines for the management of adverse effects of anti-seizure medications (2023). This guideline addresses 13 clinical questions related to the management of adverse effects of ASMs in the nervous system, cardiovascular system, and fetus. Its primary objective is to provide guidance to medical professionals specializing in pediatric neurology, neurology, and neurosurgery in China, and to facilitate their clinical practice.
Collapse
|
18
|
Hope OA, Harris KM. Management of epilepsy during pregnancy and lactation. BMJ 2023; 382:e074630. [PMID: 37684052 DOI: 10.1136/bmj-2022-074630] [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] [Indexed: 09/10/2023]
Abstract
Epilepsy is a group of neurological diseases characterized by susceptibility to recurrent seizures. Antiseizure medications (ASMs) are the mainstay of treatment, but many antiseizure medications with variable safety profiles have been approved for use. For women with epilepsy in their childbearing years, the safety profile is important for them and their unborn children, because treatment is often required to protect them from seizures during pregnancy and lactation. Since no large randomized controlled trials have investigated safety in this subgroup of people with epilepsy, pregnancy registries, cohort and case-control studies from population registries, and a few large prospective cohort studies have played an important role. Valproate, in monotherapy and polytherapy, has been associated with elevated risk of major congenital malformations and neurodevelopmental disorders in children born to mothers who took it. Topiramate and phenobarbital are also associated with elevated risks of congenital malformations and neurodevelopmental disorders, though the risks are lower than those of valproate. Lamotrigine and levetiracetam are relatively safe. Insufficient data exist to reach strong conclusions about the newest antiseizure medications such as eslicarbazepine, perampanel, brivaracetam, cannabidiol, and cenobamate. Besides antiseizure medications, other treatments such as vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation are likely safe. In general, breastfeeding does not appear to add any additional long term risks to the child. Creative ways of optimizing registry enrollment and data collection are needed to enhance patient safety.
Collapse
Affiliation(s)
- Omotola A Hope
- Houston Methodist Sugarland Neurology Associates, Houston, TX, USA
| | - Katherine Mj Harris
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA
| |
Collapse
|
19
|
Kawai S, Pak K, Iwamoto S, Kawakami C, Inuzuka R, Maeda J, Furutani Y, Kamisago M, Takatsuki S, Uyeda T, Yamagishi H, Ito S, Kobayashi T. Association Between Maternal Factors in Early Pregnancy and Congenital Heart Defects in Offspring: The Japan Environment and Children's Study. J Am Heart Assoc 2023; 12:e029268. [PMID: 37642029 PMCID: PMC10547327 DOI: 10.1161/jaha.122.029268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
Background Many prenatal factors are reported to be associated with congenital heart defects (CHD) in offspring. However, these associations have not been adequately examined using large-scale birth cohorts. Methods and Results We evaluated a data set of the Japan Environmental and Children's Study. The primary outcome was a diagnosis of CHD by age 2 years. We defined the following variables as exposures: maternal baseline characteristics, fertilization treatment, maternal history of diseases, socioeconomic status, maternal alcohol intake, smoking, tea consumption, maternal dietary intake, and maternal medications and supplements up to 12 weeks of gestation. We used multivariable logistic regression analysis to assess the associations between various exposures and CHD in offspring. A total of 91 664 singletons were included, among which 1264 (1.38%) had CHD. In multivariable analysis, vitamin A supplements (adjusted odds ratio [aOR], 5.78 [95% CI, 2.30-14.51]), maternal use of valproic acid (aOR, 4.86 [95% CI, 1.51-15.64]), maternal use of antihypertensive agents (aOR, 3.80 [95% CI, 1.74-8.29]), maternal age ≥40 years (aOR, 1.59 [95% CI, 1.14-2.20]), and high maternal hemoglobin concentration in the second trimester (aOR, 1.10 per g/dL [95% CI, 1.03-1.17]) were associated with CHD in offspring. Conclusions Using a Japanese large-scale birth cohort study, we found 6 maternal factors to be associated with CHD in offspring.
Collapse
Affiliation(s)
- Shun Kawai
- Department of PediatricsYokohama City UniversityYokohamaJapan
| | - Kyongsun Pak
- Biostatistics Unit, Department of Data ScienceNational Center for Child Health and DevelopmentTokyoJapan
| | - Shintaro Iwamoto
- Biostatistics Unit, Department of Data ScienceNational Center for Child Health and DevelopmentTokyoJapan
| | | | - Ryo Inuzuka
- Department of PediatricsThe University of Tokyo HospitalTokyoJapan
| | - Jun Maeda
- Department of CardiologyTokyo Metropolitan Children’s Medical CenterTokyoJapan
| | - Yoshiyuki Furutani
- Department of Pediatric Cardiology and Adult Congenital CardiologyTokyo Women’s Medical UniversityTokyoJapan
| | - Mitsuhiro Kamisago
- Department of PediatricsNippon Medical School Tama Nagayama HospitalTokyoJapan
| | | | - Tomomi Uyeda
- Department of Pediatric CardiologySakakibara Heart InstituteTokyoJapan
| | | | - Shuichi Ito
- Department of PediatricsYokohama City UniversityYokohamaJapan
| | - Tohru Kobayashi
- Department of Data ScienceNational Center for Child Health and DevelopmentTokyoJapan
| | | |
Collapse
|
20
|
Liu C, Pace S, Bromley R, Dobson R. Exposure to medication for neurological disease in pregnancy - time to consider the long-term implications? EClinicalMedicine 2023; 63:102157. [PMID: 37662523 PMCID: PMC10474373 DOI: 10.1016/j.eclinm.2023.102157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
A range of long-term neurological conditions may be diagnosed in young adulthood. These conditions are generally not curable, and most people need to take ongoing treatment for symptom control and/or disease modification. When chronic diseases are diagnosed before people have completed their families, there is a need to balance the potential benefits of treatment for the mother against potential risk(s) to the fetus from exposure to medications during pregnancy. Whilst available data regarding short-term fetal outcomes following treatment exposures during pregnancy is rapidly increasing, information regarding longer-term outcomes is more limited. The association of fetal exposure to valproate with serious long-term neurodevelopmental outcomes has highlighted the importance of capturing and evaluating long-term data. In this review we examine available evidence around the long-term effects of treatments used for the most common long-term neurological conditions diagnosed in early adulthood, namely epilepsy, migraine and neuroinflammatory disorders. We draw from existing literature across a range of diseases and discuss strategies to improve future knowledge.
Collapse
Affiliation(s)
- Chen Liu
- Preventive Neurology Unit, Wolfson Institute of Population Health, QMUL, UK
| | - Samuel Pace
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Rebecca Bromley
- Division of Neuroscience, School of Biological Sciences, Faculty of Medicine, Biology and Health, University of Manchester, UK
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, QMUL, UK
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
21
|
Bromley R, Adab N, Bluett-Duncan M, Clayton-Smith J, Christensen J, Edwards K, Greenhalgh J, Hill RA, Jackson CF, Khanom S, McGinty RN, Tudur Smith C, Pulman J, Marson AG. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. Cochrane Database Syst Rev 2023; 8:CD010224. [PMID: 37647086 PMCID: PMC10463554 DOI: 10.1002/14651858.cd010224.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Prenatal exposure to certain anti-seizure medications (ASMs) is associated with an increased risk of major congenital malformations (MCM). The majority of women with epilepsy continue taking ASMs throughout pregnancy and, therefore, information on the potential risks associated with ASM treatment is required. OBJECTIVES To assess the effects of prenatal exposure to ASMs on the prevalence of MCM in the child. SEARCH METHODS For the latest update of this review, we searched the following databases on 17 February 2022: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to February 16, 2022), SCOPUS (1823 onwards), and ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP). No language restrictions were imposed. SELECTION CRITERIA We included prospective cohort controlled studies, cohort studies set within pregnancy registries, randomised controlled trials and epidemiological studies using routine health record data. Participants were women with epilepsy taking ASMs; the two control groups were women without epilepsy and untreated women with epilepsy. DATA COLLECTION AND ANALYSIS Five authors independently selected studies for inclusion. Eight authors completed data extraction and/or risk of bias assessments. The primary outcome was the presence of an MCM. Secondary outcomes included specific types of MCM. Where meta-analysis was not possible, we reviewed included studies narratively. MAIN RESULTS From 12,296 abstracts, we reviewed 283 full-text publications which identified 49 studies with 128 publications between them. Data from ASM-exposed pregnancies were more numerous for prospective cohort studies (n = 17,963), than data currently available for epidemiological health record studies (n = 7913). The MCM risk for children of women without epilepsy was 2.1% (95% CI 1.5 to 3.0) in cohort studies and 3.3% (95% CI 1.5 to 7.1) in health record studies. The known risk associated with sodium valproate exposure was clear across comparisons with a pooled prevalence of 9.8% (95% CI 8.1 to 11.9) from cohort data and 9.7% (95% CI 7.1 to 13.4) from routine health record studies. This was elevated across almost all comparisons to other monotherapy ASMs, with the absolute risk differences ranging from 5% to 9%. Multiple studies found that the MCM risk is dose-dependent. Children exposed to carbamazepine had an increased MCM prevalence in both cohort studies (4.7%, 95% CI 3.7 to 5.9) and routine health record studies (4.0%, 95% CI 2.9 to 5.4) which was significantly higher than that for the children born to women without epilepsy for both cohort (RR 2.30, 95% CI 1.47 to 3.59) and routine health record studies (RR 1.14, 95% CI 0.80 to 1.64); with similar significant results in comparison to the children of women with untreated epilepsy for both cohort studies (RR 1.44, 95% CI 1.05 to 1.96) and routine health record studies (RR 1.42, 95% CI 1.10 to 1.83). For phenobarbital exposure, the prevalence was 6.3% (95% CI 4.8 to 8.3) and 8.8% (95% CI 0.0 to 9277.0) from cohort and routine health record data, respectively. This increased risk was significant in comparison to the children of women without epilepsy (RR 3.22, 95% CI 1.84 to 5.65) and those born to women with untreated epilepsy (RR 1.64, 95% CI 0.94 to 2.83) in cohort studies; data from routine health record studies was limited. For phenytoin exposure, the prevalence of MCM was elevated for cohort study data (5.4%, 95% CI 3.6 to 8.1) and routine health record data (6.8%, 95% CI 0.1 to 701.2). The prevalence of MCM was higher for phenytoin-exposed children in comparison to children of women without epilepsy (RR 3.81, 95% CI 1.91 to 7.57) and the children of women with untreated epilepsy (RR 2.01. 95% CI 1.29 to 3.12); there were no data from routine health record studies. Pooled data from cohort studies indicated a significantly increased MCM risk for children exposed to lamotrigine in comparison to children born to women without epilepsy (RR 1.99, 95% CI 1.16 to 3.39); with a risk difference (RD) indicating a 1% increased risk of MCM (RD 0.01. 95% CI 0.00 to 0.03). This was not replicated in the comparison to the children of women with untreated epilepsy (RR 1.04, 95% CI 0.66 to 1.63), which contained the largest group of lamotrigine-exposed children (> 2700). Further, a non-significant difference was also found both in comparison to the children of women without epilepsy (RR 1.19, 95% CI 0.86 to 1.64) and children born to women with untreated epilepsy (RR 1.00, 95% CI 0.79 to 1.28) from routine data studies. For levetiracetam exposure, pooled data provided similar risk ratios to women without epilepsy in cohort (RR 2.20, 95% CI 0.98 to 4.93) and routine health record studies (RR 0.67, 95% CI 0.17 to 2.66). This was supported by the pooled results from both cohort (RR 0.71, 95% CI 0.39 to 1.28) and routine health record studies (RR 0.82, 95% CI 0.39 to 1.71) when comparisons were made to the offspring of women with untreated epilepsy. For topiramate, the prevalence of MCM was 3.9% (95% CI 2.3 to 6.5) from cohort study data and 4.1% (0.0 to 27,050.1) from routine health record studies. Risk ratios were significantly higher for children exposed to topiramate in comparison to the children of women without epilepsy in cohort studies (RR 4.07, 95% CI 1.64 to 10.14) but not in a smaller comparison to the children of women with untreated epilepsy (RR 1.37, 95% CI 0.57 to 3.27); few data are currently available from routine health record studies. Exposure in utero to topiramate was also associated with significantly higher RRs in comparison to other ASMs for oro-facial clefts. Data for all other ASMs were extremely limited. Given the observational designs, all studies were at high risk of certain biases, but the biases observed across primary data collection studies and secondary use of routine health records were different and were, in part, complementary. Biases were balanced across the ASMs investigated, and it is unlikely that the differential results observed across the ASMs are solely explained by these biases. AUTHORS' CONCLUSIONS Exposure in the womb to certain ASMs was associated with an increased risk of certain MCMs which, for many, is dose-dependent.
Collapse
Affiliation(s)
- Rebecca Bromley
- Division of Neuroscience, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester, UK
| | - Naghme Adab
- Department of Neurology, A5 Corridor, Walsgrave Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Matt Bluett-Duncan
- Institute of Human Development, University of Manchester, Manchester, UK
| | - Jill Clayton-Smith
- Institute of Human Development, University of Manchester, Manchester, UK
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Katherine Edwards
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Janette Greenhalgh
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Ruaraidh A Hill
- Liverpool Reviews and Implementation Group, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Cerian F Jackson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sonia Khanom
- Institute of Human Development, University of Manchester, Manchester, UK
| | - Ronan N McGinty
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Jennifer Pulman
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| |
Collapse
|
22
|
Li R, Chen Q, Cao X, Yan H, Wang P, Huang Q, Li X, Chen F, Li Y, Kong Q, Guo C, Zhang Q, Hong Q, Liu Y, Xiong X, Han Y, Xiao X, Wang K, Wu X, Zhu X, Zhang Q, Chen L. Pregnancy characteristics and adverse outcomes in offspring of women with epilepsy: a prospective registry study from Mainland China. Front Neurol 2023; 14:1195003. [PMID: 37638195 PMCID: PMC10455922 DOI: 10.3389/fneur.2023.1195003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Objective This study aimed to explore the influencing factors of adverse outcomes in the offspring of women with epilepsy (WWE) and to analyze the changes brought about by the epilepsy knowledge popularization campaign in China (EKPCIC). Methods This nested case-control study focused on WWE and their offspring from a female epilepsy cohort in mainland China. From January 2009 to August 2022, WWE was prospectively enrolled in 32 study centers. This study aimed to observe the health outcomes of their offspring within 1 year of age. The main outcome measure assessed the health status of the offspring within their first year of age. We aimed to analyze the effects of seizures, anti-seizure medicines (ASMs), and a lack of folic acid supplementation on adverse outcomes in the offspring of WWE and to explore the changes in perinatal management and adverse outcomes of the offspring after dissemination of the EKPCIC in 2015. Additionally, subgroup analyses were conducted to compare seizure control during pregnancy between the valproate and non-valproate groups. Results In total, 781 pregnancies in 695 WWE were included, of which 186 (23.69%) had adverse outcomes. The National Hospital Epilepsy Severity Scale score, number of seizures, status epilepticus, ASM type, and valproate and folic acid doses were associated with a high risk of adverse outcomes. After the EKPCIC, the use of ASMs (P = 0.013) and folic acid (P < 0.001), the seizure-free rate during pregnancy (P = 0.013), and the breastfeeding rate (P < 0.001) increased, whereas the incidence of complications during pregnancy decreased (P = 0.013). However, there was no significant difference in the incidence of adverse outcomes between the analyzed offspring pre-/post-EKPCIC. Additionally, there was no association between the frequency of seizures at different time points during pregnancy and the use of valproate (F = 1.514, P = 0.221). Conclusion Possible factors influencing adverse outcomes in the offspring of WWE include seizures, type and number of ASM usage, and a lack of folic acid supplementation. Although the management of WWE during pregnancy is now more standardized, further efforts are needed to reduce adverse outcomes in offspring.
Collapse
Affiliation(s)
- Rui Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Clinical Research Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xing Cao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hua Yan
- Department of Neurology, Jianyang People's Hospital, Chengdu, Sichuan, China
| | - Pei Wang
- Department of Neurology, Xianyang First People's Hospital, Xianyang, Shanxi, China
| | - Qun Huang
- Department of Pediatrics, The WenJiang Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Xiaoyi Li
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Fang Chen
- Department of Neurology, Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Yangchao Li
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Qingxia Kong
- Department of Neurology, Affiliated Hospital of Jining Medical College, Jining, Shandong, China
| | - Chonglun Guo
- Epilepsy Center, Suichuan County People's Hospital, Suichuan, Jiangxi, China
| | - Qi Zhang
- Department of Neurology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Qiulei Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Liu
- Department of Neurology, The First Affiliation Hospital of Xi'an Jiaotong University, Xian, Shanxi, China
| | - Xiaoli Xiong
- Department of Neurology, Guangyuan Mental Health Center, Guangyuan, Sichuan, China
| | - Yanbing Han
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaohua Xiao
- Department of Geriatric Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangzhou, China
| | - Kuiyun Wang
- Department of Neurology, The Jintang First People's Hospital, Chengdu, Sichuan, China
| | - Xunyi Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xi Zhu
- Department of Neurology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Qing Zhang
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
23
|
Ouchida S, Nikpour A, Zhang X, Faulkner H, Senturias M, Reid N, Stephens E, Fairbrother G. The long-term outcomes of patients with negative prolonged ambulatory electroencephalography tests: A cross-sectional follow-up study. HEALTH OPEN RESEARCH 2023; 5:26. [PMID: 38708033 PMCID: PMC11065127 DOI: 10.12688/healthopenres.13351.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 05/07/2024]
Abstract
Background Ambulatory electroencephalography (AEEG) recording is an essential aid for detecting interictal discharges and providing a clinical diagnosis. This study aimed to describe long-term outcomes among a cohort of patients who yielded negative results on AEEG at the time of assessment and identify factors associated with contemporary quality of life (QOL) and ultimate epilepsy diagnosis. Methods This cross-sectional telephone follow-up study was conducted in June-November 2021 at the Neurology Department in a metropolitan hospital in Sydney, Australia. Results In total, 47 of 105 eligible (45%) participants were enrolled. Overall, 21 (45%) participants had been diagnosed with epilepsy at a 12-year follow-up. Taking anti-seizure medication, having experienced a seizure event, and having marriage and education-related characteristics were associated with an epilepsy diagnosis. QOL was found to be associated with age, employment status and history of experience of a seizure event. QOL and an epilepsy diagnosis were not shown to be statistically related. Conclusions Nearly half of the participants had received an epilepsy diagnosis at long-term follow-up, despite having tested negative on AEEG at the time of assessment. Prolonged AEEG testing is an important tool to aid the diagnostic process. However, clinical examination, including accurate history taking, is vital in establishing an epilepsy diagnosis.
Collapse
Affiliation(s)
- Sumika Ouchida
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
| | - Armin Nikpour
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2050, Australia
| | - Xin Zhang
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
| | - Howard Faulkner
- Department of Neurology, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Maricar Senturias
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
| | - Nicole Reid
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
| | - Eleanor Stephens
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Greg Fairbrother
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2050, Australia
- Sydney Reseach, Sydney Local Health District, Camperdown, New South Wales, 2050, Australia
| |
Collapse
|
24
|
Abtahi S, Pajouheshnia R, Durán CE, Riera-Arnau J, Gamba M, Alsina E, Hoxhaj V, Andersen M, Bartolini C, Kristiansen SB, Brown J, Hallgreen CE, Garcia-Poza P, Gardarsdottir H, Gini R, Girardi A, Holthuis E, Huerta C, Ibánez L, Limoncella G, Martín-Pérez M, Paoletti O, Roberto G, Souverein P, Swart KMA, Wing K, Sturkenboom M, Klungel O. Impact of 2018 EU Risk Minimisation Measures and Revised Pregnancy Prevention Programme on Utilisation and Prescribing Trends of Medicinal Products Containing Valproate: An Interrupted Time Series Study. Drug Saf 2023:10.1007/s40264-023-01314-3. [PMID: 37294532 DOI: 10.1007/s40264-023-01314-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Due to established teratogenicity of valproates, the EU risk minimisation measures (RMMs) with a pregnancy prevention programme (PPP) for valproate were updated in March 2018. OBJECTIVES To investigate the effectiveness of the 2018 EU RMMs on valproate utilisation in five European countries/regions. METHODS A multi-database, times series study of females of childbearing potential (12-55 years) was conducted using electronic medical records from five countries/regions (01.01.2010-31.12.2020): Denmark, Tuscany (Italy), Spain, the Netherlands, and the UK. Clinical and demographic information from each database was transformed to the ConcePTION Common Data Model, quality checks were conducted and a distributed analysis was performed using common scripts. Incident and prevalent use of valproate, proportion of discontinuers and switchers to alternative medicine, frequency of contraception coverage during valproate use, and occurrence of pregnancies during valproate exposure were estimated per month. Interrupted time series analyses were conducted to estimate the level or trend change in the outcome measures. RESULTS We included 69,533 valproate users from 9,699,371 females of childbearing potential from the five participating centres. A significant decline in prevalent use of valproates was observed in Tuscany, Italy (mean difference post-intervention -7.7%), Spain (-11.3%), and UK (-5.9%) and a non-significant decline in the Netherlands (-3.3%), but no decline in incident use after the 2018 RMMs compared to the period before. The monthly proportion of compliant valproate prescriptions/dispensings with a contraceptive coverage was low (<25%), with an increase after the 2018 RMMs only in the Netherlands (mean difference post-intervention 12%). There was no significant increase in switching rates from valproates to alternative medicine after the 2018 intervention in any of the countries/regions. We observed a substantial number of concurrent pregnancies during valproate exposure, but with a declining rate after the 2018 RMMs in Tuscany, Italy (0.70 per 1000 valproate users pre- and 0.27 post-intervention), Spain (0.48 and 0.13), the Netherlands (0.34 and 0.00), and an increasing rate in UK (1.13 and 5.07). CONCLUSION There was a small impact of the 2018 RMMs on valproate use in the studied European countries/regions. The substantial number of concurrent pregnancies with valproate exposure warrants a careful monitoring of implementation of the existing PPP for valproate in clinical practice in Europe, to see if there is any need for additional measures in the future.
Collapse
Affiliation(s)
- Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Carlos E Durán
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Judit Riera-Arnau
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Clinical Pharmacology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Magdalena Gamba
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Ema Alsina
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Vjola Hoxhaj
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Brøgger Kristiansen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeremy Brown
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Christine Erikstrup Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- Department of Clinical Pharmacy, UMCU, Utrecht, The Netherlands
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | - Anna Girardi
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | - Emily Holthuis
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Consuelo Huerta
- Department of Public Health, Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Luisa Ibánez
- Clinical Pharmacology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Mar Martín-Pérez
- Agencia Espanola de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Olga Paoletti
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | | | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Kevin Wing
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
| |
Collapse
|
25
|
Behan C, Hynes S, Ennis P, Khalil MI, Hogan J, Brett F, Sweeney K, Kilbride R, Doherty CP. Neurosurgery for intractable epilepsy in pregnancy: A case report. Epilepsy Behav Rep 2023; 23:100607. [PMID: 37283698 PMCID: PMC10239692 DOI: 10.1016/j.ebr.2023.100607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
We describe the management of a 39-year-old woman with intractable focal epilepsy whose condition deteriorated during pregnancy and who required emergency neurosurgery. A literature search did not identify any previous reports of epilepsy surgery in pregnancy. To our knowledge, this is the first time surgery was planned and executed in rapid order with a successful outcome, without obstetrical or surgical complications and seizure freedom achieved. The value of rapid communication between established women's health advanced nurse practitioner clinics, the multidisciplinary Epilepsy Surgery Group and specialist Obstetrical Epilepsy service is highlighted. A care cycle for pregnant women with refractory epilepsy is proposed.
Collapse
Affiliation(s)
- Claire Behan
- Neurology Dept., St. James's Hospital, Ireland
- School of Medicine, Trinity College Dublin, Ireland
- FutureNeuro SFI Research Centre, RSCI, Ireland
| | | | | | | | - Jennifer Hogan
- The Coombe, Women and Infants University Hospital, Ireland
| | | | | | - Ronan Kilbride
- Neurology Dept., Beaumont Hospital, Ireland
- FutureNeuro SFI Research Centre, RSCI, Ireland
| | - Colin P Doherty
- Neurology Dept., St. James's Hospital, Ireland
- School of Medicine, Trinity College Dublin, Ireland
- FutureNeuro SFI Research Centre, RSCI, Ireland
| |
Collapse
|
26
|
Piccus R, Thaller M, Sinclair AJ, Mollan SP. Current and emerging diagnostic and management approaches for idiopathic intracranial hypertension. Expert Rev Neurother 2023; 23:457-466. [PMID: 37114519 DOI: 10.1080/14737175.2023.2206567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Idiopathic intracranial hypertension is characterized by raised intracranial pressure that triggers disabling headaches and can cause permanent visual loss. There is an increased incidence and prevalence of the condition linked to location-specific obesity rates. There are no licensed treatments for the condition. The majority of approaches to managing the disease prioritize resolution of papilledema. However, evidence is emerging that idiopathic intracranial hypertension is a systemic metabolic disease. AREAS COVERED The aim of this review is to present the emerging pathophysiology evidence which is leading to novel targeted therapeutics. The diagnostic pathway is outlined. The current and potential management approaches for idiopathic intracranial hypertension are also discussed. EXPERT OPINION Idiopathic intracranial hypertension is a condition with metabolic dysregulation with systemic manifestations that are present over and above what can be expl.ained by obesity alone. While most of the current management of this condition focuses on the eyes, future management needs to address the disabling headaches and the systemic risks of preeclampsia, gestational diabetes, and major cardiovascular events.
Collapse
Affiliation(s)
- Ravi Piccus
- Medical school, University of Birmingham, Birmingham, UK
| | - Mark Thaller
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Alexandra J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Susan P Mollan
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
27
|
Lopes das Neves P, Ventura R, Sobral-Pinho A, Silva E, Morgadinho A, Vitor J, Miranda M, Madureira B, Moniz Dionísio J, Pinheiro R, Delgado S, Carapinha D, Rego A, S Á F, Pelejão MR, Antunes F, Marques I, Brito da Silva V, Castro Sousa S, Peres J, Martins A, Tojal R. [Evaluation of the Knowledge of Women of Childbearing Age with Epilepsy about the Impact of Their Disease in Contraception, Pregnancy and Breastfeeding: A Multicenter Cross-Sectional Study]. ACTA MEDICA PORT 2023. [PMID: 36977340 DOI: 10.20344/amp.19156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/31/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The interaction of antiseizure medication with contraceptives, its potential teratogenicity and implications in pregnancy and breastfeeding are aspects to consider in the neurological care of women with epilepsy of childbearing age. To ensure the commitment in therapeutic decisions and the appropriate planning of maternity, it is essential that women are informed about the implications of their disease in these domains. The main aim of this study was to assess the knowledge of women of childbearing age with epilepsy concerning the impact of epilepsy in contraception, pregnancy and breastfeeding. As secondary aims we defined (1) the demographic, clinical and therapeutic characterization of this group of patients, (2) the identification of variables that correlated with the level of knowledge of women with epilepsy, and (3) the identification of preferential methods to acquire new knowledge about epilepsy. MATERIAL AND METHODS The study was observational, cross-sectional and multicentric, and was carried out in five hospitals of the Lisbon metropolitan area. After identifying all women of childbearing age with epilepsy followed in the epilepsy clinic of each center, we applied an electronic questionnaire based on a non-systematic review of the literature. RESULTS One hundred and fourteen participants were validated, with a median age of 33 years. Half of the participants were on monotherapy, and the majority had no seizures in the last six months. We identified important gaps in the participants' knowledge. Sections about complications and administration of antiseizure medication during pregnancy were the ones with the worst results. None of the clinical and demographic variables correlated with the final questionnaire score. Having had a previous pregnancy and the desire to breastfeed in a future pregnancy were positively correlated with the performance in breastfeeding section. Face-to-face discussion during medical outpatient visits was selected as the preferential method to learn about epilepsy, and the internet and social media were the least preferred ones. CONCLUSION The knowledge of women of childbearing age with epilepsy in the Lisbon metropolitan area concerning the impact of epilepsy in contraception, pregnancy and breastfeeding seems to have significant gaps. Medical teams should consider engaging in patient education particularly during outpatient clinics.
Collapse
Affiliation(s)
- Pedro Lopes das Neves
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Rita Ventura
- Serviço de Neurologia. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | - André Sobral-Pinho
- Serviço de Neurologia. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | - Elisa Silva
- Serviço de Neurologia. Hospital Garcia de Orta. Almada. Portugal
| | | | - Joana Vitor
- Serviço de Neurologia. Hospital Beatriz Ângelo. Loures. Portugal
| | - Miguel Miranda
- Serviço de Neurologia. Hospital de Cascais Dr. José de Almeida. Cascais. Portugal
| | - Beatriz Madureira
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Joana Moniz Dionísio
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Rita Pinheiro
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Sofia Delgado
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Duarte Carapinha
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - André Rego
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Francisca S Á
- Serviço de Neurologia. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | - Maria Rita Pelejão
- Serviço de Neurologia. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | | | - Inês Marques
- Serviço de Neurologia. Hospital Garcia de Orta. Almada. Portugal
| | | | - Sandra Castro Sousa
- Serviço de Neurologia. Hospital de Cascais Dr. José de Almeida. Cascais. Portugal
| | - João Peres
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - António Martins
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Raquel Tojal
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| |
Collapse
|
28
|
Tao S, Chen B, Xu X, Hu S, Lu J. Case report: rTMS in combination with aripiprazole and sodium valproate for the maintenance treatment of rapid cycling bipolar disorder. Front Psychiatry 2023; 14:1070046. [PMID: 37009128 PMCID: PMC10060647 DOI: 10.3389/fpsyt.2023.1070046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
As a safe neuromodulation therapy, rTMS is applied to treat a variety of psychiatric and neurological disorders. Additionally, both aripiprazole and sodium valproate are effective in the treatment of rapid cycling bipolar disorder. This case reports a female patient with a 17-year history of bipolar disorder who developed rapid-circulation bipolar disorder 5 years prior to presentation. After combined treatment with rTMS, aripiprazole, and sodium valproate, the patient’s mood remained stable and she was able to live and work normally.
Collapse
Affiliation(s)
- Siyi Tao
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bing Chen
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofang Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
- *Correspondence: Shaohua Hu,
| | - Jing Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
- Jing Lu,
| |
Collapse
|
29
|
Spiteri JA, Camilleri G, Piccinni C, Sultana J. Safety of drugs used for the treatment of migraine during pregnancy: a narrative review. Expert Rev Clin Pharmacol 2023; 16:207-217. [PMID: 36803196 DOI: 10.1080/17512433.2023.2181157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Migraine is common in females of childbearing age and negatively impacts quality of life. The majority of those with migraine who become pregnant see an improvement in their condition but not all do. Providing evidence-based recommendations for the pharmacological management of migraine in pregnancy is challenging. AREAS COVERED This narrative review provides an update on the safety of drugs used for migraine in pregnancy. National and international guidelines on the management of episodic migraine in adults were used to select the drugs of relevance to pregnant women. The final list of drugs was chosen by a pain specialist who categorized them according to drug class and use in acute management or prevention. PubMed was searched from inception to 31st July 2022 for evidence on drug safety. EXPERT OPINION Obtaining high-quality drug safety data in pregnant migraineurs is difficult not least because exposing a fetus to research-related risks is often considered unethical. There is reliance on observational studies which often group drugs together and lack specificities pertinent to drug prescribing like timing, dosing and duration. Improved statistical tools, study designs and the creation of international collaborative frameworks are ways to advance knowledge on drug safety in pregnancy.
Collapse
Affiliation(s)
- Jessica A Spiteri
- Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Triq Dun Karm, Malta
| | - Gabrielle Camilleri
- Department of Clinical Pharmacology and Therapeutics, University of Malta, Msida MSD, Malta
| | - Carlo Piccinni
- Fondazione Ricerca e Salute (ReS)-Research and Health Foundation, Casalecchio di Reno, Italy
| | - Janet Sultana
- Exeter College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
30
|
Marson T. Maintaining equity and reducing risk when prescribing valproate: we still have a way to go. Pract Neurol 2023; 23:4-5. [PMID: 36717205 DOI: 10.1136/pn-2022-003685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Tony Marson
- Pharmacology and Therapeutics, University of Liverpool, Liverpool, Merseyside, UK .,The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
31
|
Maguire MJ, Fairclough S, Nevitt SJ. Antiepileptic drugs for treating seizures in people with brain tumours. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023. [PMCID: PMC9890922 DOI: 10.1002/14651858.cd015467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To compare the efficacy and tolerability of antiepileptic drugs (AEDs) taken as monotherapy or add‐on therapy for seizures in people with brain tumours.
Collapse
Affiliation(s)
| | | | | | - Sarah J Nevitt
- Department of Health Data ScienceUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
32
|
Hendawi EK, Khabour OF, Al-Eitan LN, Alzoubi KH. Reduction of Genotoxicity of Carbamazepine to Human Lymphocytes by Pre-treatment with Vitamin B12. Curr Mol Pharmacol 2023; 16:228-233. [PMID: 35450538 DOI: 10.2174/1874467215666220420135924] [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] [Received: 11/13/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Carbamazepine (CBZ) is widely used as an anti-epileptic drug. Vitamin B12 has been shown to protect against DNA damage caused by several mutagenic agents. OBJECTIVE This study aimed to investigate the effect of vitamin B12 on CBZ-induced genotoxicity in cultured human lymphocytes. METHODS Sister chromatid exchanges (SCEs) and chromosomal aberrations (CAs) genotoxic assays were utilized to achieve the study objective. RESULTS The results showed significantly higher frequencies of CAs and SCEs in the CBZ-treated cultures (12 μg/mL) compared to the control group (P<0.01). The genotoxic effects of CBZ were reduced by pre-treatment of cultures with vitamin B12 (13.5μg/ml, P<0.05). Neither CBZ nor vitamin B-12 showed any effects on mitotic and proliferative indices. CONCLUSION CBZ is genotoxic to lymphocyte cells, and this genotoxicity can be reduced by vitamin B12.
Collapse
Affiliation(s)
- Eman K Hendawi
- Department of Applied Biological Sciences, Faculty of Science, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Laith N Al-Eitan
- Department of Applied Biological Sciences, Faculty of Science, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, UAE
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
33
|
Ziganshina LE, Abakumova T, Hoyle CHV. Gabapentin monotherapy for epilepsy: A review. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2023; 34:243-286. [PMID: 37393439 DOI: 10.3233/jrs-235001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
BACKGROUND Epilepsy is one of the most common chronic neurological disorders, affecting more than 50 million people globally. In this review we summarised the evidence from randomised controlled trials of gabapentin used as monotherapy for the treatment of focal epilepsy, both newly diagnosed and drug-resistant, with or without secondary generalisation. OBJECTIVE To assess the effects of gabapentin monotherapy for people with epileptic focal seizures with and without secondary generalisation. METHODS We searched the Cochrane Register of Studies (CRS Web) and MEDLINE (Ovid, 1946 to 24 February 2020) on 25 February 2020. CRS Web includes randomised or quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, the Cochrane Central Register of Controlled Trials (CENTRA), and the specialised registers of Cochrane Review Groups including the Cochrane Epilepsy Group. We also searched several Russian databases, reference lists of relevant studies, ongoing trials registers, conference proceedings, and we contacted trial authors. RESULTS We found five randomised controlled trials (3167 participants) comparing gabapentin to other antiepileptic drugs (AEDs) and differing doses of gabapentin as monotherapy for newly diagnosed focal epilepsy and drug- resistant focal epilepsy with or without secondary generalisation. Two review authors independently applied the inclusion criteria, assessed trial quality, risk of bias, and extracted data. We used the GRADE approach to assess the certainty of evidence and present seven patient-important outcomes in the "Summary of findings" tables. The quality of evidence was very low to moderate due to poor reporting quality, poor trial design, and other risks of bias, such as selective presentation of findings and potential heavy industry input. Better quality research may change our certainty in the effect estimates. None of the included trials reported on the number of people with 50% or greater reduction in seizures and time to withdrawal (retention time) in an extractable way. Gabapentin-treated participants were more likely to withdraw from treatment for any cause (285/539) than those treated with lamotrigine, oxcarbazepine, or topiramate pooled together (695/1317) (RR 1.13, 95% CI 1.02 to 1.25; 3 studies, 1856 participants; moderate-certainty evidence), but not carbamazepine. Fewer people treated with gabapentin withdrew from treatment owing to adverse events (190/525) than those treated with carbamazepine, oxcarbazepine, or topiramate (479/1238), (RR 0.79, 95% CI 0.69 to 0.91; 1763 participants, 3 studies; moderate-certainty evidence), but not lamotrigine. CONCLUSION Gabapentin as monotherapy probably controlled seizures no better and no worse than comparator AEDs (lamotrigine, carbamazepine, oxcarbazepine, and topiramate). Compared to carbamazepine, gabapentin was probably better in retaining people in studies and preventing withdrawals due to adverse events. The most common side effects associated with gabapentin were ataxia (poor co-ordination and unsteady gait), dizziness, fatigue, and drowsiness.
Collapse
Affiliation(s)
- Liliya Eugenevna Ziganshina
- Centre for Knowledge Translation, Federal State Budgetary Educational Institution of Continuing Professional Education "Russian Medical Academy of Continuing Professional Education", The Ministry of Health of the Russian Federation (RMANPO), Moscow, Russian Federation
- Department of Pharmacology, Kazan State Medical University (KSMU), The Ministry of Health of the Russian Federation, Kazan, Russian Federation
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russian Federation
| | - Tatyana Abakumova
- Department of Biochemistry, Biotechnology and Pharmacology, Kazan (Volga region) Federal University, Kazan, Russian Federation
| | | |
Collapse
|
34
|
Compliance with Prescribing and Dispensing Conditions for Valproate and Related Substances in Girls and Women of Childbearing Potential: A Survey of Community Pharmacists in France. Drug Saf 2023; 46:121-128. [PMID: 36287388 PMCID: PMC9607717 DOI: 10.1007/s40264-022-01234-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Prenatal exposure to valproate and related substances is associated with a risk of malformations and/or neurodevelopmental disorders. In France, prescription and dispensing conditions of oral valproate forms are subject to risk minimization measures for girls and women of childbearing potential with the aim to limit pregnancy under this treatment. These risk minimization measures were issued in 2015 and were strengthened in 2018. OBJECTIVE We aimed to evaluate compliance with prescription and dispensing conditions of valproate for oral administration: an annual prescription from a specialist and a signed risk acknowledgment form. METHODS Two prospective observational surveys were carried out between 2018 and 2020 on a representative sample of French community pharmacies. Data were collected from female patients aged 2-49 years presenting to one of the participating pharmacies with a valproate prescription. RESULTS In total, 1067 and 824 valproate prescriptions were analyzed in 2018 and 2020, respectively, the majority of which were for girls and women of childbearing potential (≥ 92%). The prescription and dispensing conditions for valproate were met in 42% of cases (95% confidence interval 39-45) in 2018 and in 47% of cases (95% confidence interval 43-50) in 2020. Compliance levels were higher for prescriptions from neurologists (≥ 60%) than from other prescribers (≤ 45%). CONCLUSIONS In France, the implementation of specific risk minimization measures for girls and women of childbearing potential with respect to oral valproate forms and related substances requires a stronger involvement of stakeholders. Increased awareness and compliance among healthcare professionals regarding risk minimization measures could limit prenatal exposure to valproate.
Collapse
|
35
|
Yang R, Liu S, Yin N, Zhang Y, Faiola F. Tox21-Based Comparative Analyses for the Identification of Potential Toxic Effects of Environmental Pollutants. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:14668-14679. [PMID: 36178254 DOI: 10.1021/acs.est.2c04467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Chemical pollution has become a prominent environmental problem. In recent years, quantitative high-throughput screening (qHTS) assays have been developed for the fast assessment of chemicals' toxic effects. Toxicology in the 21st Century (Tox21) is a well-known and continuously developing qHTS project. Recent reports utilizing Tox21 data have mainly focused on setting up mathematical models for in vivo toxicity predictions, with less attention to intuitive qHTS data visualization. In this study, we attempted to reveal and summarize the toxic effects of environmental pollutants by analyzing and visualizing Tox21 qHTS data. Via PubMed text mining, toxicity/structure clustering, and manual classification, we detected a total of 158 chemicals of environmental concern (COECs) from the Tox21 library that we classified into 13 COEC groups based on structure and activity similarities. By visualizing these COEC groups' bioactivities, we demonstrated that COECs frequently displayed androgen and progesterone antagonistic effects, xenobiotic receptor agonistic roles, and mitochondrial toxicity. We also revealed many other potential targets of the 13 COEC groups, which were not well illustrated yet, and that current Tox21 assays may not correctly classify known teratogens. In conclusion, we provide a feasible method to intuitively understand qHTS data.
Collapse
Affiliation(s)
- Renjun Yang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, 18 Shuangqing Road, Beijing 100085, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shuyu Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, 18 Shuangqing Road, Beijing 100085, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
- Wellcome Trust/CRUK Gurdon Institute, Department of Pathology, University of Cambridge, Cambridge CB2 1QN, U.K
| | - Nuoya Yin
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, 18 Shuangqing Road, Beijing 100085, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yang Zhang
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Francesco Faiola
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, 18 Shuangqing Road, Beijing 100085, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| |
Collapse
|
36
|
Ranjith S, Joshi A. Measures to Mitigate Sodium Valproate Use in Pregnant Women With Epilepsy. Cureus 2022; 14:e30144. [PMID: 36381886 PMCID: PMC9643024 DOI: 10.7759/cureus.30144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Sodium valproate is a sodium salt of valproic acid. It is often used in the medical treatment of several conditions like epilepsy, bipolar disorder, mania, and migraines. This review debates whether the usage of valproic acid is appropriate in pregnancy. It also lists the various neonatal deformities and other teratogenic effects the said drug presents due to prenatal exposure to the drug and the implications of continuing drug therapy in certain situations. We should often weigh the outcomes and implement it only in conditions where its use is inevitable. It also includes the importance of awareness among middle-aged women with mental illness regarding the teratogenic effects of sodium valproate use and the relevance of discussion by physicians with patients regarding the usage of this drug despite being aware of the complications. It also explores other treatment options and modalities that can be used in the place of valproic acid for epilepsy and bipolar disorder in pregnant women and women of the reproductive age group, and how we can mitigate the usage of this drug by implementing various measures by referring to various guidelines present in different areas of the world. In summary, this article explores the numerous teratogenic effects sodium valproate presents in pregnancy, alternative medications, and treatment options instead of valproate. It also enumerates conditions where valproate use is necessary and how we can reduce and prevent the usage of valproate in pregnancy by opting for pregnancy prevention programs during valproate use and various other guidelines.
Collapse
|
37
|
Jin XL, Song BH, Zhao XD, Huang GB. Neonatal outcomes after gamma-aminobutyric acid analog use during pregnancy: a meta-analysis of cohort studies. Eur J Clin Pharmacol 2022; 78:1739-1747. [DOI: 10.1007/s00228-022-03384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/03/2022] [Indexed: 11/03/2022]
|
38
|
Byth LA, Lust K, Jeffree RL, Paine M, Voldanova L, Craven AM. Management of idiopathic intracranial hypertension in pregnancy. Obstet Med 2022; 15:160-167. [PMID: 36262821 PMCID: PMC9574447 DOI: 10.1177/1753495x211021333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/11/2021] [Indexed: 09/03/2023] Open
Abstract
Idiopathic intracranial hypertension is more common among women of reproductive age and is often encountered in pregnancy, either pre-existing and exacerbated by pregnancy-associated weight gain and hormonal changes or arising de novo. We report the case of a 33-year-old woman with progressive visual loss and intractable headache from 20 weeks' gestation requiring ventriculoperitoneal shunting during pregnancy. The risk of permanent maternal vision loss raises complex management dilemmas, when this must be balanced with the fetal and neonatal risks of treatment and possible premature delivery.
Collapse
Affiliation(s)
- Lachlan Andrew Byth
- Department of Obstetric Medicine, Royal Brisbane and Women’s
Hospital, Herston, Australia
- Griffith University School of Medicine, Southport,
Australia
| | - Karin Lust
- Department of Obstetric Medicine, Royal Brisbane and Women’s
Hospital, Herston, Australia
- University of Queensland School of Medicine, Herston,
Australia
| | - Rosalind L Jeffree
- Department of Neurosurgery, Royal Brisbane and Women’s Hospital,
Herston, Australia
- University of Queensland School of Medicine, Herston,
Australia
| | - Mark Paine
- Department of Neurology, Royal Brisbane and Women’s Hospital,
Herston, Australia
| | - Lucie Voldanova
- Department of Anaesthesia, Royal Brisbane and Women’s Hospital,
Herston, Australia
| | - Ann-Maree Craven
- Department of Obstetric Medicine, Royal Brisbane and Women’s
Hospital, Herston, Australia
| |
Collapse
|
39
|
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
|
40
|
Spina Bifida: A Review of the Genetics, Pathophysiology and Emerging Cellular Therapies. J Dev Biol 2022; 10:jdb10020022. [PMID: 35735913 PMCID: PMC9224552 DOI: 10.3390/jdb10020022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 12/11/2022] Open
Abstract
Spina bifida is the most common congenital defect of the central nervous system which can portend lifelong disability to those afflicted. While the complete underpinnings of this disease are yet to be fully understood, there have been great advances in the genetic and molecular underpinnings of this disease. Moreover, the treatment for spina bifida has made great advancements, from surgical closure of the defect after birth to the now state-of-the-art intrauterine repair. This review will touch upon the genetics, embryology, and pathophysiology and conclude with a discussion on current therapy, as well as the first FDA-approved clinical trial utilizing stem cells as treatment for spina bifida.
Collapse
|
41
|
Thaller M, Wakerley BR, Abbott S, Tahrani AA, Mollan SP, Sinclair AJ. Managing idiopathic intracranial hypertension in pregnancy: practical advice. Pract Neurol 2022; 22:295-300. [PMID: 35450962 PMCID: PMC9304112 DOI: 10.1136/practneurol-2021-003152] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 01/18/2023]
Abstract
Idiopathic intracranial hypertension (IIH) is more common in women of reproductive age who have obesity, yet there is little information on its management specifically in pregnancy. Women with IIH should plan their pregnancy including discussing contraception before pregnancy, recognising that hormonal contraceptives are not contraindicated. Potentially teratogenic medications including acetazolamide and topiramate are not recommended during pregnancy or in those with immediate plans to conceive; prescribing acetazolamide in pregnancy must only follow discussion with the patient and their obstetrician. Ideally, patients should aim to achieve disease remission or control before pregnancy, through optimising their weight. Although weight gain is expected in pregnancy, excessive weight gain may exacerbate IIH and increase maternal and fetal complications; evidence-based recommendations for non-IIH pregnancies may help in guiding optimal gestational weight gain. The vast majority of women with IIH can have a normal vaginal delivery, with spinal or epidural anaesthesia if needed, provided the papilloedema is stable or the IIH is in remission.
Collapse
Affiliation(s)
- Mark Thaller
- Metabolic Neurology, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK .,Neurology, Queen Elizabeth Hospital, Birmingham, UK
| | - Benjamin R Wakerley
- Metabolic Neurology, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK.,Neurology, Queen Elizabeth Hospital, Birmingham, UK
| | - Sally Abbott
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Diabetes and Endocrinology, Queen Elizabeth Hospital, Birmingham, UK
| | - Susan P Mollan
- Metabolic Neurology, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK.,Birmingham Neuro-Ophthalmology Unit, Ophthalmology Department, Queen Elizabeth Hospital, Birmingham, UK
| | - Alexandra J Sinclair
- Metabolic Neurology, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK .,Neurology, Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
42
|
Roberti R, Rocca M, Iannone LF, Gasparini S, Pascarella A, Neri S, Cianci V, Bilo L, Russo E, Quaresima P, Aguglia U, Di Carlo C, Ferlazzo E. Status epilepticus in pregnancy: a literature review and a protocol proposal. Expert Rev Neurother 2022; 22:301-312. [PMID: 35317697 DOI: 10.1080/14737175.2022.2057224] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Status epilepticus (SE) in pregnancy represents a life-threatening medical emergency for both mother and fetus. Pregnancy-related pharmacokinetic modifications and the risks for fetus associated with the use of antiseizure medications (ASMs) and anesthetic drugs complicate SE management. No standardized treatment protocol for SE in pregnancy is available to date. AREAS COVERED In this review, we provide an overview of the current literature on the management of SE in pregnancy and we propose a multidisciplinary-based protocol approach. EXPERT OPINION Literature data are scarce (mainly anecdotal case reports or small case series). Prompt treatment of SE during pregnancy is paramount and a multidisciplinary team is needed. Benzodiazepines are the drugs of choice for SE in pregnancy. Levetiracetam and phenytoin represent the most suitable second-line agents. Valproic acid should be administered only if other ASMs failed and preferably avoided in the first trimester of pregnancy. For refractory SE, anesthetic drugs are needed, with propofol and midazolam as preferred drugs. Magnesium sulfate is the first-line treatment for SE in eclampsia. Termination of pregnancy, via delivery or abortion, is recommended in case of failure of general anesthetics. Further studies are needed to identify the safest and most effective treatment protocol.
Collapse
Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Morena Rocca
- Obstetrics and Gynecology Unit, "Pugliese-ciaccio" Hospital of Catanzaro, Catanzaro, Italy
| | | | - Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Angelo Pascarella
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Sabrina Neri
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Leonilda Bilo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Paola Quaresima
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Costantino Di Carlo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| |
Collapse
|
43
|
Degremont A, Kerbrat S, Balusson F, Jonville-Bera AP, Ringa V, Travers D, Tillaut H, Leray E, Oger E, Birben A, Polard E. Prescribing Trends for Valproate Among Pregnant Women: A Cross-sectional Study in 2013 and 2016 Using the French Health Insurance Database. Neurology 2022; 98:e2163-e2173. [PMID: 35379759 DOI: 10.1212/wnl.0000000000200260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to describe the prescribing trends for sodium valproate (VPA) and alternative drugs during and around pregnancy, comparing 2016 (after the recommendations on valproate for women were reinforced by the EMA) to 2013 (before the recommendations). METHODS Using the French National Health Insurance Database, a cross-sectional study was carried out in 2013 and in 2016, including women who became pregnant and had at least one reimbursement claim for VPA in the two years prior to pregnancy or during pregnancy. Exposure to VPA and its alternatives was then measured for each quarter, in the two years before pregnancy (pre-conception), during pregnancy and in the year after pregnancy (post-partum). RESULTS Among pregnant women with epilepsy (N=2,607 pregnancies), the proportion exposed to VPA during pregnancy decreased from 26.4% to 9.3% between 2013 and 2016, alongside an increase in lamotrigine and levetiracetam use. Among pregnant women with bipolar disorder (N=4,278 pregnancies), the proportion of women exposed during pregnancy decreased from 3.7% in 2013 to 1.9% in 2016, without any switch to alternative drugs. In both populations, less than one third had consulted a specialist before pregnancy. CONCLUSION As recommended by the EMA, a change in practice over the period 2013-2016 was observed, with fewer women exposed to VPA during pregnancy and before pregnancy. However, in 2016, a large number of women were exposed to VPA in the first trimester of pregnancy (N=471), which could suggest that the timing of pregnancy should be better planned whenever possible.
Collapse
Affiliation(s)
- Adeline Degremont
- Pharmaco-vigilance, Pharmaco-epidemiology and Drug Information Centre, Department of Clinical Pharmacology, CHU de Rennes, Rennes, France .,EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Sandrine Kerbrat
- EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Frédéric Balusson
- Pharmaco-vigilance, Pharmaco-epidemiology and Drug Information Centre, Department of Clinical Pharmacology, CHU de Rennes, Rennes, France.,EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Annie Pierre Jonville-Bera
- Pharmaco-vigilance and Drug Information Centre, Department of Pharmaco-surveillance, CHU de Tours, Tours, France
| | - Virginie Ringa
- INSERM CESP (Centre de recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Villejuif, France
| | - David Travers
- Department of Psychiatry, CHU de Rennes, Rennes, France
| | - Hélène Tillaut
- Department of Health Epidemiology and biostatistics for decision-making in public health, EHESP (School for Public Health), Rennes, France
| | - Emmanuelle Leray
- Department of Health Epidemiology and biostatistics for decision-making in public health, EHESP (School for Public Health), Rennes, France
| | - Emmanuel Oger
- Pharmaco-vigilance, Pharmaco-epidemiology and Drug Information Centre, Department of Clinical Pharmacology, CHU de Rennes, Rennes, France.,EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Arnaud Birben
- Epilepsy unit, Department of Neurology, CHU de Rennes, Rennes, France.,INSERM 1099, Signal and Image Processing Laboratory, Univ Rennes, Rennes, France
| | - Elisabeth Polard
- Pharmaco-vigilance, Pharmaco-epidemiology and Drug Information Centre, Department of Clinical Pharmacology, CHU de Rennes, Rennes, France.,EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| |
Collapse
|
44
|
Nevitt SJ, Sudell M, Cividini S, Marson AG, Tudur Smith C. Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data. Cochrane Database Syst Rev 2022; 4:CD011412. [PMID: 35363878 PMCID: PMC8974892 DOI: 10.1002/14651858.cd011412.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in 2017. Epilepsy is a common neurological condition with a worldwide prevalence of around 1%. Approximately 60% to 70% of people with epilepsy will achieve a longer-term remission from seizures, and most achieve that remission shortly after starting antiepileptic drug treatment. Most people with epilepsy are treated with a single antiepileptic drug (monotherapy) and current guidelines from the National Institute for Health and Care Excellence (NICE) in the United Kingdom for adults and children recommend carbamazepine or lamotrigine as first-line treatment for focal onset seizures and sodium valproate for generalised onset seizures; however, a range of other antiepileptic drug (AED) treatments are available, and evidence is needed regarding their comparative effectiveness in order to inform treatment choices. OBJECTIVES To compare the time to treatment failure, remission and first seizure of 12 AEDs (carbamazepine, phenytoin, sodium valproate, phenobarbitone, oxcarbazepine, lamotrigine, gabapentin, topiramate, levetiracetam, zonisamide, eslicarbazepine acetate, lacosamide) currently used as monotherapy in children and adults with focal onset seizures (simple focal, complex focal or secondary generalised) or generalised tonic-clonic seizures with or without other generalised seizure types (absence, myoclonus). SEARCH METHODS For the latest update, we searched the following databases on 12 April 2021: the Cochrane Register of Studies (CRS Web), which includes PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Epilepsy Group Specialised Register and MEDLINE (Ovid, 1946 to April 09, 2021). We handsearched relevant journals and contacted pharmaceutical companies, original trial investigators and experts in the field. SELECTION CRITERIA We included randomised controlled trials of a monotherapy design in adults or children with focal onset seizures or generalised onset tonic-clonic seizures (with or without other generalised seizure types). DATA COLLECTION AND ANALYSIS This was an individual participant data (IPD) and network meta-analysis (NMA) review. Our primary outcome was 'time to treatment failure', and our secondary outcomes were 'time to achieve 12-month remission', 'time to achieve six-month remission', and 'time to first seizure post-randomisation'. We performed frequentist NMA to combine direct evidence with indirect evidence across the treatment network of 12 drugs. We investigated inconsistency between direct 'pairwise' estimates and NMA results via node splitting. Results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs) and we assessed the certainty of the evidence using the CiNeMA approach, based on the GRADE framework. We have also provided a narrative summary of the most commonly reported adverse events. MAIN RESULTS IPD were provided for at least one outcome of this review for 14,789 out of a total of 22,049 eligible participants (67% of total data) from 39 out of the 89 eligible trials (43% of total trials). We could not include IPD from the remaining 50 trials in analysis for a variety of reasons, such as being unable to contact an author or sponsor to request data, data being lost or no longer available, cost and resources required to prepare data being prohibitive, or local authority or country-specific restrictions. No IPD were available from a single trial of eslicarbazepine acetate, so this AED could not be included in the NMA. Network meta-analysis showed high-certainty evidence that for our primary outcome, 'time to treatment failure', for individuals with focal seizures; lamotrigine performs better than most other treatments in terms of treatment failure for any reason and due to adverse events, including the other first-line treatment carbamazepine; HRs (95% CIs) for treatment failure for any reason for lamotrigine versus: levetiracetam 1.01 (0.88 to 1.20), zonisamide 1.18 (0.96 to 1.44), lacosamide 1.19 (0.90 to 1.58), carbamazepine 1.26 (1.10 to 1.44), oxcarbazepine 1.30 (1.02 to 1.66), sodium valproate 1.35 (1.09 to 1.69), phenytoin 1.44 (1.11 to 1.85), topiramate 1.50 (1.23 to 1.81), gabapentin 1.53 (1.26 to 1.85), phenobarbitone 1.97 (1.45 to 2.67). No significant difference between lamotrigine and levetiracetam was shown for any treatment failure outcome, and both AEDs seemed to perform better than all other AEDs. For people with generalised onset seizures, evidence was more limited and of moderate certainty; no other treatment performed better than first-line treatment sodium valproate, but there were no differences between sodium valproate, lamotrigine or levetiracetam in terms of treatment failure; HRs (95% CIs) for treatment failure for any reason for sodium valproate versus: lamotrigine 1.06 (0.81 to 1.37), levetiracetam 1.13 (0.89 to 1.42), gabapentin 1.13 (0.61 to 2.11), phenytoin 1.17 (0.80 to 1.73), oxcarbazepine 1.24 (0.72 to 2.14), topiramate 1.37 (1.06 to 1.77), carbamazepine 1.52 (1.18 to 1.96), phenobarbitone 2.13 (1.20 to 3.79), lacosamide 2.64 (1.14 to 6.09). Network meta-analysis also showed high-certainty evidence that for secondary remission outcomes, few notable differences were shown for either seizure type; for individuals with focal seizures, carbamazepine performed better than gabapentin (12-month remission) and sodium valproate (six-month remission). No differences between lamotrigine and any AED were shown for individuals with focal seizures, or between sodium valproate and other AEDs for individuals with generalised onset seizures. Network meta-analysis also showed high- to moderate-certainty evidence that, for 'time to first seizure,' in general, the earliest licensed treatments (phenytoin and phenobarbitone) performed better than the other treatments for individuals with focal seizures; phenobarbitone performed better than both first-line treatments carbamazepine and lamotrigine. There were no notable differences between the newer drugs (oxcarbazepine, topiramate, gabapentin, levetiracetam, zonisamide and lacosamide) for either seizure type. Generally, direct evidence (where available) and network meta-analysis estimates were numerically similar and consistent with confidence intervals of effect sizes overlapping. There was no important indication of inconsistency between direct and network meta-analysis results. The most commonly reported adverse events across all drugs were drowsiness/fatigue, headache or migraine, gastrointestinal disturbances, dizziness/faintness and rash or skin disorders; however, reporting of adverse events was highly variable across AEDs and across studies. AUTHORS' CONCLUSIONS High-certainty evidence demonstrates that for people with focal onset seizures, current first-line treatment options carbamazepine and lamotrigine, as well as newer drug levetiracetam, show the best profile in terms of treatment failure and seizure control as first-line treatments. For people with generalised tonic-clonic seizures (with or without other seizure types), current first-line treatment sodium valproate has the best profile compared to all other treatments, but lamotrigine and levetiracetam would be the most suitable alternative first-line treatments, particularly for those for whom sodium valproate may not be an appropriate treatment option. Further evidence from randomised controlled trials recruiting individuals with generalised tonic-clonic seizures (with or without other seizure types) is needed.
Collapse
Affiliation(s)
- Sarah J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Maria Sudell
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| |
Collapse
|
45
|
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
|
46
|
Lee JH, Shin H, Shaker MR, Kim HJ, Park SH, Kim JH, Lee N, Kang M, Cho S, Kwak TH, Kim JW, Song MR, Kwon SH, Han DW, Lee S, Choi SY, Rhyu IJ, Kim H, Geum D, Cho IJ, Sun W. Production of human spinal-cord organoids recapitulating neural-tube morphogenesis. Nat Biomed Eng 2022; 6:435-448. [PMID: 35347276 DOI: 10.1038/s41551-022-00868-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
Abstract
Human spinal-cord-like tissues induced from human pluripotent stem cells are typically insufficiently mature and do not mimic the morphological features of neurulation. Here, we report a three-dimensional culture system and protocol for the production of human spinal-cord-like organoids (hSCOs) recapitulating the neurulation-like tube-forming morphogenesis of the early spinal cord. The hSCOs exhibited neurulation-like tube-forming morphogenesis, cellular differentiation into the major types of spinal-cord neurons as well as glial cells, and mature synaptic functional activities, among other features of the development of the spinal cord. We used the hSCOs to screen for antiepileptic drugs that can cause neural-tube defects. hSCOs may also facilitate the study of the development of the human spinal cord and the modelling of diseases associated with neural-tube defects.
Collapse
Affiliation(s)
- Ju-Hyun Lee
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyogeun Shin
- Center for BioMicrosystems, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea
| | - Mohammed R Shaker
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Si-Hyung Park
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - June Hoan Kim
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Namwon Lee
- InterMinds Inc., Seongnam, Republic of Korea
| | - Minjin Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Subin Cho
- Department of Bio-Information Science, Ewha Womans University, Seoul, Republic of Korea
| | - Tae Hwan Kwak
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jong Woon Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Mi-Ryoung Song
- School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Seung-Hae Kwon
- Seoul Center, Korea Basic Science Institute, Seoul, Republic of Korea
| | - Dong Wook Han
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Sanghyuk Lee
- Department of Bio-Information Science, Ewha Womans University, Seoul, Republic of Korea.,Department of Life Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Se-Young Choi
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Im Joo Rhyu
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Kim
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dongho Geum
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Il-Joo Cho
- Center for BioMicrosystems, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.,School of Electrical and Electronics Engineering, Yonsei University, Seoul, Republic of Korea
| | - Woong Sun
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
47
|
Twenty-year trends in the use of anti-seizure medication among pregnant women in the Netherlands. Epilepsy Behav 2022; 127:108549. [PMID: 35042161 DOI: 10.1016/j.yebeh.2021.108549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anti-seizure medications (ASMs) are used to treat conditions such as epilepsy and bipolar disorder. Some of these drugs are associated with an increased risk of congenital malformations and adverse developmental outcomes. OBJECTIVES To examine trends in use of ASMs among pregnant women in the Netherlands according to medication safety profile. METHODS Using population-based data from the PHARMO Perinatal Research Network, we assessed trends in use of ASMs among pregnant women in the Netherlands between 1999 and 2019, stratified by medication safety profile. Individual treatment patterns were also assessed. RESULTS In total, 671,709 pregnancies among 446,169 women were selected, of which 2405 (3.6 per 1000) were ASM-exposed. Over the study period, a significant increase was observed for use of known safest ASMs (0.7-18.0 per 10,000 pregnancies) as well as for those with uncertain risk (5.3-13.4 per 10,000 pregnancies). Use of ASMs with higher risk of congenital malformations decreased significantly (24.8-14.5 per 10,000 pregnancies), except for topiramate (0-6.7 per 10,000 pregnancies). Switches between ASM safety risk categories before and during pregnancy were uncommon; women rather discontinued treatment or switched within the same category. There was no clear change for the proportion using polytherapy during pregnancy (12% overall), however a non-significant trend toward inclusion of known safest ASMs was observed over time (1.9-3.6%). CONCLUSIONS Over the last two decades, there has been an increase in use of known safest ASMs among pregnant women, together with a trend toward newer ASMs with uncertain risk. Only a small proportion of women switched to a safer alternative before or during pregnancy. Altogether, this highlights the need for an expansion of ASM risk knowledge and communication to healthcare providers and women of reproductive age to improve preconception counseling.
Collapse
|
48
|
Epilepsy in Pregnancy—Management Principles and Focus on Valproate. Int J Mol Sci 2022; 23:ijms23031369. [PMID: 35163292 PMCID: PMC8836209 DOI: 10.3390/ijms23031369] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
An estimated 60 million people worldwide suffer from epilepsy, half of whom are women. About one-third of women with epilepsy are of childbearing age. The childbirth rate in women with epilepsy is about 20–40% lower compared to that of the general population, which may be partly due to a lower number of these women being in relationships. Lower fertility in women with epilepsy may be linked to the disease itself, but it is mainly a result of the treatment provided. Valproate, as an antiepileptic drug inhibiting histone deacetylases, may affect the expression of genes associated with cell cycle control and cellular differentiation. Evidently, this drug is associated with the risk of malformations although other antiepileptic drugs (AEDs) may also trigger birth defects, however, to a lower degree. Valproate (and to a certain degree other AEDs) may induce autism spectrum disorders and attention deficit hyperactivity disorder. The main mechanism responsible for all negative effects of prenatal exposure to valproate seems inhibition of histone deacetylases. Animal studies show a reduction in the expression of genes involved in social behavior and an increase in hippocampal cytokines. Valproate-induced oxidative stress may also contribute to neural tube defects. Interestingly, paternal exposure to this AED in mice may trigger neurodevelopmental disorders as well although a population-based cohort study does not confirm this effect. To lower the risk of congenital malformations and neurodevelopmental disorders, a single AED at the optimal dose and supplementation with folic acid is recommended. VPA should be avoided in women of childbearing age and especially during pregnancy.
Collapse
|
49
|
Krämer S, Wirtz H. [Molecule pathology in the treatment of lung cancer-Interdisciplinary view of the importance in thoracic surgery]. Chirurg 2021; 93:485-489. [PMID: 34905081 PMCID: PMC9042959 DOI: 10.1007/s00104-021-01544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
Die Therapie des Lungenkarzinoms wurde in den letzten Jahren zunehmend durch die Etablierung tumorspezifisch zielgerichteter Pharmaka und immunmodulatorischer Ansätze ergänzt und hat dadurch rasant an Komplexität gewonnen. Bessere Überlebensdaten und Erkenntnisse über andere Nebenwirkungensspektren und Rezidivcharakteristika begleiten diese Entwicklung. Dem Kliniker verlangt diese Entwicklung eine stete Wachsamkeit in der Stratifizierung der Behandlungsoptionen ab. Dieser Artikel gibt einen Überblick über die klinisch aktuell relevanten Ansätze der „targeted therapies“ in der Behandlung des Lungenkarzinoms und stellt Verbindungen zur Thoraxchirurgie dar. Mit der Darstellung der Optionen einer zielgerichteter Therapie wird beantwortet, welche Rolle sie in der adjuvanten Therapie bei nachgewiesener Mutation des Epidermal-growth-factor-Rezeptors (EGFR) spielen, wann eine Salvage-Operation infrage kommt und wie durch die „targeted therapies“ in Einzelfällen ein kuratives Therapiekonzept erarbeitet werden kann. Jedes Lungenkarzinom verlangt ab dem frühestmöglichen Zeitpunkt in der Diagnosefindung nach einer molekularen Analyse auf therapierelevante Mutationsmuster. Interdisziplinäre Konzepte können individualisiert das Langzeitüberleben des Patienten gewährleisten.
Collapse
Affiliation(s)
- Sebastian Krämer
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland.
| | - Hubert Wirtz
- Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Bereich Pneumologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| |
Collapse
|
50
|
Kacirova I, Grundmann M, Brozmanova H. Valproic Acid Concentrations in Mothers, Colostrum and Breastfed Infants during the Early Postpartum Period: Comparison with Concentrations Determined during Delivery and in the Mature Milk Period. Pharmaceutics 2021; 13:pharmaceutics13122074. [PMID: 34959355 PMCID: PMC8708593 DOI: 10.3390/pharmaceutics13122074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
To obtain information on the transport of valproic acid from mothers to colostrum and breastfed infants, in this cohort study, valproic acid concentrations in maternal serum (90 subjects), colostrum and the serum of breastfed infants were analyzed in years 1993–2018, between the 2nd and 5th postnatal days. Valproic acid concentrations ranged from 4.3 to 66.5 mg/L (mean 31.2 ± 13.6 mg/L) in maternal serum, from 0.5 to 5.9 mg/L (mean 1.1 ± 1.2 mg/L) in milk, and from 0.5 to 42.9 mg/L (mean 15.4 ± 9.4 mg/L) in infant serum. The milk/maternal serum concentration ratio ranged from 0.01 to 0.22 (mean 0.04 ± 0.04), and the infant/maternal serum concentration ratio ranged from 0.01 to 1.61 (mean 0.51 ± 0.28). A significant correlation was found between serum concentrations of breastfed infants and milk concentrations, maternal serum concentrations, maternal daily dose, and dose related to maternal body weight. Valproic acid concentrations in milk and infant serum did not reach the lower limit of the reference range used for the general epileptic population, and three-quarters of the concentrations in milk were lower than the lower limit of quantification. Routine monitoring of serum concentrations of breastfed infants is not necessary. If signs of potential adverse reactions are noted, serum concentrations of the infants should be measured.
Collapse
Affiliation(s)
- Ivana Kacirova
- Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic; (I.K.); (H.B.)
- Department of Laboratory Medicine, Institute of Clinical Pharmacology, University Hospital Ostrava, 70852 Ostrava, Czech Republic
| | - Milan Grundmann
- Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic; (I.K.); (H.B.)
- Department of Laboratory Medicine, Institute of Clinical Pharmacology, University Hospital Ostrava, 70852 Ostrava, Czech Republic
- Correspondence: ; Tel.: +420-59-737-4389
| | - Hana Brozmanova
- Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic; (I.K.); (H.B.)
- Department of Laboratory Medicine, Institute of Clinical Pharmacology, University Hospital Ostrava, 70852 Ostrava, Czech Republic
| |
Collapse
|