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Desrochers B, Lavu A, Valencia E, Vaccaro C, Peymani P, Eltonsy S. Risks of congenital malformations and neonatal intensive care unit admissions with gabapentin use in pregnancy: A cohort study and scoping review with meta-analysis. Paediatr Perinat Epidemiol 2024. [PMID: 38773683 DOI: 10.1111/ppe.13086] [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: 05/15/2023] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND The increasing and prevalent use of gabapentin among pregnant people highlights the necessity to assess its neonatal safety. OBJECTIVES This study aimed to investigate the foetal safety of gabapentin during pregnancy using a cohort study and scoping review with a meta-analysis of published evidence. METHODS We conducted a population-based cohort study using the Manitoba health databases between 1995 and 2019. We examined the association between gabapentin use during pregnancy and the prevalence of major congenital malformations, cardiac and orofacial malformations, and neonatal intensive care unit (NICU) admissions using multivariate regression models. We searched the literature in MEDLINE and EMBASE databases from inception to October 2022 to identify relevant observational studies and conducted a meta-analysis using random-effects models, including our cohort study results. RESULTS Of the 289,227 included pregnancies, 870 pregnant people were exposed to gabapentin. Gabapentin exposure during the First trimester was not associated with an increased risk of any malformations (adjusted relative risk [aRR]) 1.16 (95% confidence interval [CI] 0.92, 1.46), cardiac malformations (aRR 1.29, 95% CI 0.72, 2.29), orofacial malformations (aRR 1.37, 95% CI 0.50, 3.75), and major congenital malformations (aRR 1.00, 95% CI 0.73, 1.36). whereas exposure during any trimester was associated with an increased NICU admission risk (aRR, 1.99 [95% CI 1.70, 2.32]). The meta-analysis of unadjusted results revealed an increased risk of major congenital malformations (RR 1.44, 95% CI 1.28, 1.61, I2 = 0%), cardiac malformations (RR 1.66, 95% CI 1.11, 2.47, I2 = 68%), and NICU admissions (RR 3.15, 95% CI 2.90, 3.41, I2 = 10%), and increased trend of orofacial malformations (RR 1.98, 95% CI 0.79, 5.00, I2 = 0%). CONCLUSIONS Gabapentin use was associated with an increased risk of NICU admissions in the cohort study and pooled meta-analysis. Clinicians should prescribe gabapentin with caution during pregnancy and further studies are warranted.
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Affiliation(s)
| | - Alekhya Lavu
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eunice Valencia
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine Vaccaro
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Payam Peymani
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sherif Eltonsy
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Mukherjee SK, Papadakis JE, Arman DM, Islam J, Azim M, Rahman A, Ekramullah SM, Suchanda HS, Farooque A, Warf BC, Mazumdar M. The Importance of Neurosurgical Intervention and Surgical Timing for Management of Pediatric Patients with Myelomeningoceles in Bangladesh. World Neurosurg 2024:S1878-8750(24)00718-6. [PMID: 38685347 DOI: 10.1016/j.wneu.2024.04.144] [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: 12/29/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Reports on the management and survival of children with myelomeningocele defects in Bangladesh are limited. This study describes the characteristics and outcomes of these children, focusing on the timing of surgical repair and factors affecting survival. METHODS We enrolled patients with myelomeningoceles in a case-control study on arsenic exposure and spina bifida in Bangladesh. Cases were subsequently followed at regular intervals to assess survival. Demographic, clinical, and surgical characteristics were reviewed. Univariate tests identified factors affecting survival. RESULTS Between 2016 and 2022, we enrolled 272 patients with myelomeningocele. Postnatal surgical repair was performed in 63% of cases. However, surgery within 5 days after birth was infrequent (<10%) due to delayed presentation, and there was a high rate (29%) of preoperative deaths. Surgical repair significantly improved patient survival (P < 0.0001). Older age at time of surgery was also associated with improved survival rates, which most likely represents that those who survived to older ages prior to surgery accommodated better with their lesions. Patients who presented with ruptured lesions had lower survival rates. CONCLUSIONS Timely neurosurgical repair of myelomeningoceles in Bangladesh is hindered by late patient presentation, resulting in a high preoperative patient death rate. Neurosurgical intervention remains a significant predictor of survival. Increased access to neurosurgical care and education of families and non-neurosurgical providers on the need for timely surgical intervention are important for improving the survival of infants with myelomeningoceles.
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Affiliation(s)
- Sudipta Kumer Mukherjee
- Department of Paediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS), Dhaka, Bangladesh
| | - Joanna E Papadakis
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - D M Arman
- Department of Paediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS), Dhaka, Bangladesh
| | - Joynul Islam
- Department of Paediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS), Dhaka, Bangladesh
| | | | - Asifur Rahman
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Sheikh Muhammad Ekramullah
- Department of Paediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS), Dhaka, Bangladesh
| | - Hafiza Sultana Suchanda
- Paediatric Neurosurgery Research Committee, National Institute of Neurosciences & Hospital (NINS), Dhaka, Bangladesh
| | - Afifah Farooque
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin C Warf
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maitreyi Mazumdar
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Iffland M, Livingstone N, Jorgensen M, Hazell P, Gillies D. Pharmacological intervention for irritability, aggression, and self-injury in autism spectrum disorder (ASD). Cochrane Database Syst Rev 2023; 10:CD011769. [PMID: 37811711 PMCID: PMC10561353 DOI: 10.1002/14651858.cd011769.pub2] [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] [Indexed: 10/10/2023]
Abstract
BACKGROUND Pharmacological interventions are frequently used for people with autism spectrum disorder (ASD) to manage behaviours of concern, including irritability, aggression, and self-injury. Some pharmacological interventions might help treat some behaviours of concern, but can also have adverse effects (AEs). OBJECTIVES To assess the effectiveness and AEs of pharmacological interventions for managing the behaviours of irritability, aggression, and self-injury in ASD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 11 other databases and two trials registers up to June 2022. We also searched reference lists of relevant studies, and contacted study authors, experts and pharmaceutical companies. SELECTION CRITERIA We included randomised controlled trials of participants of any age with a clinical diagnosis of ASD, that compared any pharmacological intervention to an alternative drug, standard care, placebo, or wait-list control. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes were behaviours of concern in ASD, (irritability, aggression and self-injury); and AEs. Secondary outcomes were quality of life, and tolerability and acceptability. Two review authors independently assessed each study for risk of bias, and used GRADE to judge the certainty of the evidence for each outcome. MAIN RESULTS We included 131 studies involving 7014 participants in this review. We identified 26 studies as awaiting classification and 25 as ongoing. Most studies involved children (53 studies involved only children under 13 years), children and adolescents (37 studies), adolescents only (2 studies) children and adults (16 studies), or adults only (23 studies). All included studies compared a pharmacological intervention to a placebo or to another pharmacological intervention. Atypical antipsychotics versus placebo At short-term follow-up (up to 6 months), atypical antipsychotics probably reduce irritability compared to placebo (standardised mean difference (SMD) -0.90, 95% confidence interval (CI) -1.25 to -0.55, 12 studies, 973 participants; moderate-certainty evidence), which may indicate a large effect. However, there was no clear evidence of a difference in aggression between groups (SMD -0.44, 95% CI -0.89 to 0.01; 1 study, 77 participants; very low-certainty evidence). Atypical antipsychotics may also reduce self-injury (SMD -1.43, 95% CI -2.24 to -0.61; 1 study, 30 participants; low-certainty evidence), possibly indicating a large effect. There may be higher rates of neurological AEs (dizziness, fatigue, sedation, somnolence, and tremor) in the intervention group (low-certainty evidence), but there was no clear evidence of an effect on other neurological AEs. Increased appetite may be higher in the intervention group (low-certainty evidence), but we found no clear evidence of an effect on other metabolic AEs. There was no clear evidence of differences between groups in musculoskeletal or psychological AEs. Neurohormones versus placebo At short-term follow-up, neurohormones may have minimal to no clear effect on irritability when compared to placebo (SMD -0.18, 95% CI -0.37 to -0.00; 8 studies; 466 participants; very low-certainty evidence), although the evidence is very uncertain. No data were reported for aggression or self -injury. Neurohormones may reduce the risk of headaches slightly in the intervention group, although the evidence is very uncertain. There was no clear evidence of an effect of neurohormones on any other neurological AEs, nor on any psychological, metabolic, or musculoskeletal AEs (low- and very low-certainty evidence). Attention-deficit hyperactivity disorder (ADHD)-related medications versus placebo At short-term follow-up, ADHD-related medications may reduce irritability slightly (SMD -0.20, 95% CI -0.40 to -0.01; 10 studies, 400 participants; low-certainty evidence), which may indicate a small effect. However, there was no clear evidence that ADHD-related medications have an effect on self-injury (SMD -0.62, 95% CI -1.63 to 0.39; 1 study, 16 participants; very low-certainty evidence). No data were reported for aggression. Rates of neurological AEs (drowsiness, emotional AEs, fatigue, headache, insomnia, and irritability), metabolic AEs (decreased appetite) and psychological AEs (depression) may be higher in the intervention group, although the evidence is very uncertain (very low-certainty evidence). There was no evidence of a difference between groups for any other metabolic, neurological, or psychological AEs (very low-certainty evidence). No data were reported for musculoskeletal AEs. Antidepressants versus placebo At short-term follow-up, there was no clear evidence that antidepressants have an effect on irritability (SMD -0.06, 95% CI -0.30 to 0.18; 3 studies, 267 participants; low-certainty evidence). No data for aggression or self-injury were reported or could be included in the analysis. Rates of metabolic AEs (decreased energy) may be higher in participants receiving antidepressants (very low-certainty evidence), although no other metabolic AEs showed clear evidence of a difference. Rates of neurological AEs (decreased attention) and psychological AEs (impulsive behaviour and stereotypy) may also be higher in the intervention group (very low-certainty evidence) although the evidence is very uncertain. There was no clear evidence of any difference in the other metabolic, neurological, or psychological AEs (very low-certainty evidence), nor between groups in musculoskeletal AEs (very low-certainty evidence). Risk of bias We rated most of the studies across the four comparisons at unclear overall risk of bias due to having multiple domains rated as unclear, very few rated as low across all domains, and most having at least one domain rated as high risk of bias. AUTHORS' CONCLUSIONS Evidence suggests that atypical antipsychotics probably reduce irritability, ADHD-related medications may reduce irritability slightly, and neurohormones may have little to no effect on irritability in the short term in people with ASD. There was some evidence that atypical antipsychotics may reduce self-injury in the short term, although the evidence is uncertain. There was no clear evidence that antidepressants had an effect on irritability. There was also little to no difference in aggression between atypical antipsychotics and placebo, or self-injury between ADHD-related medications and placebo. However, there was some evidence that atypical antipsychotics may result in a large reduction in self-injury, although the evidence is uncertain. No data were reported (or could be used) for self-injury or aggression for neurohormones versus placebo. Studies reported a wide range of potential AEs. Atypical antipsychotics and ADHD-related medications in particular were associated with an increased risk of metabolic and neurological AEs, although the evidence is uncertain for atypical antipsychotics and very uncertain for ADHD-related medications. The other drug classes had minimal or no associated AEs.
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Affiliation(s)
- Michelle Iffland
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
| | - Nuala Livingstone
- Cochrane Evidence Production and Methods Directorate , Cochrane, London, UK
| | - Mikaela Jorgensen
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Donna Gillies
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
- Sydney, Australia
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Zemet R, Krispin E, Johnson RM, Kumar NR, Westerfield LE, Stover S, Mann DG, Castillo J, Castillo HA, Nassr AA, Sanz Cortes M, Donepudi R, Espinoza J, Whitehead WE, Belfort MA, Shamshirsaz AA, Van den Veyver IB. Implication of chromosomal microarray analysis prior to in-utero repair of fetal open neural tube defect. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:719-727. [PMID: 36610024 PMCID: PMC10238557 DOI: 10.1002/uog.26152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In-utero repair of open neural tube defects (ONTD) is an accepted treatment option with demonstrated superior outcome for eligible patients. While current guidelines recommend genetic testing by chromosomal microarray analysis (CMA) when a major congenital anomaly is detected prenatally, the requirement for an in-utero repair, based on the Management of Myelomeningocele Study (MOMS) criteria, is a normal karyotype. In this study, we aimed to evaluate if CMA should be recommended as a prerequisite for in-utero ONTD repair. METHODS This was a retrospective cohort study of pregnancies complicated by ONTD that underwent laparotomy-assisted fetoscopic repair or open-hysterotomy fetal surgery at a single tertiary center between September 2011 and July 2021. All patients met the MOMS eligibility criteria and had a normal karyotype. In a subset of the pregnancies (n = 77), CMA testing was also conducted. We reviewed the CMA results and divided the cohort into two groups according to whether clinically reportable copy-number variants (CNV) were detected (reportable-CNV group) or not (normal-CMA group). Surgical characteristics, complications, and maternal and early neonatal outcomes were compared between the two groups. The primary outcomes were fetal or neonatal death, hydrocephalus, motor function at 12 months of age and walking status at 30 months of age. Standard parametric and non-parametric statistical tests were employed as appropriate. RESULTS During the study period, 146 fetuses with ONTD were eligible for and underwent in-utero repair. CMA results were available for 77 (52.7%) patients. Of those, 65 (84%) had a normal CMA and 12 (16%) had a reportable CNV, two of which were classified as pathogenic. The first case with a pathogenic CNV was diagnosed with a 749-kb central 22q11.21 deletion spanning low-copy-repeat regions B-D of chromosome 22; the second case was diagnosed with a 1.3-Mb interstitial deletion at 1q21.1q21.2. Maternal demographics, clinical characteristics, operative data and postoperative complications were similar between those with normal CMA results and those with reportable CNVs. There were no significant differences in gestational age at delivery or any obstetric and early neonatal outcome between the study groups. Motor function at birth and at 12 months of age, and walking status at 30 months of age, were similar between the two groups. CONCLUSIONS Standard diagnostic testing with CMA should be offered when an ONTD is detected prenatally, as this approach has implications for counseling regarding prognosis and recurrence risk. Our results indicate that the presence of a clinically reportable CNV should not a priori affect eligibility for in-utero repair, as overall pregnancy outcome is similar in these cases to that of cases with normal CMA. Nevertheless, significant CMA results will require a case-by-case multidisciplinary discussion to evaluate eligibility. To generalize the conclusion of this single-center series, a larger, multicenter long-term study should be considered. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R. Zemet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - E. Krispin
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - R. M. Johnson
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - N. R. Kumar
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L. E. Westerfield
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine and Reproductive and Prenatal Genetics, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - S. Stover
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - D. G. Mann
- Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Clinical Ethics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - J. Castillo
- Division of Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - H. A. Castillo
- Division of Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - A. A. Nassr
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - M. Sanz Cortes
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - R. Donepudi
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - J. Espinoza
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - W. E. Whitehead
- Department of Neurosurgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - M. A. Belfort
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - A. A. Shamshirsaz
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
| | - I. B. Van den Veyver
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Maternal–Fetal Medicine, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine and Reproductive and Prenatal Genetics, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, TX, USA
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Dell'Apa D, Fumeo M, Volta A, Bernardini M, Fidanzio F, Buffagni V, Christen M, Jagannathan V, Leeb T, Bianchi E. Case report: Sacral agenesis in two boxer dogs: clinical presentation, diagnostic investigations, and outcome. Front Vet Sci 2023; 10:1201484. [PMID: 37303726 PMCID: PMC10248164 DOI: 10.3389/fvets.2023.1201484] [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: 04/06/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Two boxer dogs from the same litter were presented at 3 months of age for urinary and fecal incontinence. Both dogs had an abnormal tail consisting of a small stump, an atonic anal sphincter, and absent perineal reflex and sensation. Neurological evaluation was indicative of a lesion of the cauda equina or sacral spinal cord. Radiology and CT scan of the spine displayed similar findings in the two dogs that were indicative of sacral agenesis. Indeed, they had 6 lumbar vertebrae followed by a lumbosacral transitional vertebra, lacking a complete spinous process, and a hypoplastic vertebra carrying 2 hypoplastic sacral transverse processes as the only remnant of the sacral bone. Caudal vertebrae were absent in one of the dogs. On MRI, one dog had a dural sac occupying the entire spinal canal and ending in a subfascial fat structure. In the other dog, the dural sac finished in an extracanalar, subfascial, well-defined cystic structure, communicating with the subarachnoid space, and consistent with a meningocele. Sacral agenesis-that is the partial or complete absence of the sacral bones-is a neural tube defect occasionally reported in humans with spina bifida occulta. Sacral agenesis has been described in human and veterinary medicine in association with conditions such as caudal regression syndrome, perosomus elumbis, and Currarino syndrome. These neural tube defects are caused by genetic and/or environmental factors. Despite thorough genetic investigation, no candidate variants in genes with known functional impact on bone development or sacral development could be found in the affected dogs. To the best of the authors' knowledge, this is the first report describing similar sacral agenesis in two related boxer dogs.
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Affiliation(s)
- Diletta Dell'Apa
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Martina Fumeo
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Antonella Volta
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Marco Bernardini
- Neurodiagnostic Unit, Anicura Portoni Rossi Veterinary Hospital, Bologna, Italy
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Italy
| | | | | | - Matthias Christen
- Vetsuisse Faculty, Institute of Genetics, University of Bern, Bern, Switzerland
| | - Vidhya Jagannathan
- Vetsuisse Faculty, Institute of Genetics, University of Bern, Bern, Switzerland
| | - Tosso Leeb
- Vetsuisse Faculty, Institute of Genetics, University of Bern, Bern, Switzerland
| | - Ezio Bianchi
- Department of Veterinary Science, University of Parma, Parma, Italy
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Avis d’experts français sur la prise en charge des femmes en âge de procréer et enceintes souffrant d’un trouble bipolaire traitées par valproate. L'ENCEPHALE 2022; 48:624-631. [DOI: 10.1016/j.encep.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/19/2022]
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Sarkisova K, van Luijtelaar G. The impact of early-life environment on absence epilepsy and neuropsychiatric comorbidities. IBRO Neurosci Rep 2022; 13:436-468. [PMID: 36386598 PMCID: PMC9649966 DOI: 10.1016/j.ibneur.2022.10.012] [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: 09/30/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
This review discusses the long-term effects of early-life environment on epileptogenesis, epilepsy, and neuropsychiatric comorbidities with an emphasis on the absence epilepsy. The WAG/Rij rat strain is a well-validated genetic model of absence epilepsy with mild depression-like (dysthymia) comorbidity. Although pathologic phenotype in WAG/Rij rats is genetically determined, convincing evidence presented in this review suggests that the absence epilepsy and depression-like comorbidity in WAG/Rij rats may be governed by early-life events, such as prenatal drug exposure, early-life stress, neonatal maternal separation, neonatal handling, maternal care, environmental enrichment, neonatal sensory impairments, neonatal tactile stimulation, and maternal diet. The data, as presented here, indicate that some early environmental events can promote and accelerate the development of absence seizures and their neuropsychiatric comorbidities, while others may exert anti-epileptogenic and disease-modifying effects. The early environment can lead to phenotypic alterations in offspring due to epigenetic modifications of gene expression, which may have maladaptive consequences or represent a therapeutic value. Targeting DNA methylation with a maternal methyl-enriched diet during the perinatal period appears to be a new preventive epigenetic anti-absence therapy. A number of caveats related to the maternal methyl-enriched diet and prospects for future research are discussed.
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Affiliation(s)
- Karine Sarkisova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova str. 5a, Moscow 117485, Russia
| | - Gilles van Luijtelaar
- Donders Institute for Brain, Cognition, and Behavior, Donders Center for Cognition, Radboud University, Nijmegen, PO Box 9104, 6500 HE Nijmegen, the Netherlands
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Podgorac J, Sekulić S, Petković B, Stojadinović G, Martać L, Pešić V. The influence of continuous prenatal exposure to valproic acid on physical, nociceptive, emotional and psychomotor responses during adolescence in mice: Dose-related effects within sexes. Front Behav Neurosci 2022; 16:982811. [PMID: 36248030 PMCID: PMC9557044 DOI: 10.3389/fnbeh.2022.982811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Clinical findings show that the use of valproic acid (VPA) during pregnancy increases the risk of birth defects and autism spectrum disorder in offspring. Although there is a consensus that monitoring of potential long-term outcomes of VPA exposure is needed, especially in undiagnosed individuals, preclinical studies addressing this issue are rare. The present study examined the effects of continuous intrauterine exposure to a wide dose range of VPA (50, 100, 200, and 400 mg/kg/day) on the physical and behavioral response in peripubertal mice as a rodent model of adolescence. Body weight and the hot plate test [on postnatal days (PND) 25 and 32], the elevated plus-maze test (on PND35), and the open field test (on PND40) served to examine physical growth, the supraspinal reflex response to a painful thermal stimulus and conditional learning, anxiety-like/risk-assessment behavior, as well as novelty-induced psychomotor activity, respectively. VPA exposure produced the following responses: (i) a negative effect on body weight, except for the dose of 100 mg/kg/day in both sexes; (ii) an increase in the percentage of animals that responded to the thermal stimulus above the defined cut-off time interval and the response latency in both sexes; (iii) dose-specific changes within sexes in behavior provoked by a novel anxiogenic environment, i.e., in females less anxiety-like/risk-assessment behavior in response to the lowest exposure dose, and in males more pronounced anxiety-like/risk-assessment behavior after exposure to the highest dose and 100 mg/kg/day; (iv) dose-specific changes within sexes in novelty-induced psychomotor activity, i.e., in females a decrease in stereotypy-like activity along with an increase in rearing, and in males a decrease in stereotypy-like activity only. These findings show that continuous intrauterine exposure to VPA produces maladaptive functioning in different behavioral domains in adolescence and that the consequences are delicate to assess as they are dose-related within sexes.
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Affiliation(s)
- Jelena Podgorac
- Department of Neurophysiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Slobodan Sekulić
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Branka Petković
- Department of Neurophysiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Gordana Stojadinović
- Department of Neurophysiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Martać
- Department of Neurophysiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Vesna Pešić
- Department of Neurobiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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9
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Di Filippo S, Godoy DA, Manca M, Paolessi C, Bilotta F, Meseguer A, Severgnini P, Pelosi P, Badenes R, Robba C. Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint. Front Neurol 2022; 13:911460. [PMID: 35756939 PMCID: PMC9218270 DOI: 10.3389/fneur.2022.911460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Moderate and severe traumatic brain injury (TBI) are major causes of disability and death. In addition, when TBI occurs during pregnancy, it can lead to miscarriage, premature birth, and maternal/fetal death, engendering clinical and ethical issues. Several recommendations have been proposed for the management of TBI patients; however, none of these have been specifically applied to pregnant women, which often have been excluded from major trials. Therefore, at present, evidence on TBI management in pregnant women is limited and mostly based on clinical experience. The aim of this manuscript is to provide the clinicians with practical suggestions, based on 10 rules, for the management of moderate to severe TBI during pregnancy. In particular, we firstly describe the pathophysiological changes occurring during pregnancy; then we explore the main strategies for the diagnosis of TBI taking in consideration the risks related to mother and fetus, and finally we discuss the most appropriate approaches for the management in this particular condition. Based on the available evidence, we suggest a stepwise approach consisting of different tiers of treatment and we describe the specific risks according to the severity of the neurological and systemic conditions of both fetus and mother in relation to each trimester of pregnancy. The innovative feature of this approach is the fact that it focuses on the vulnerability and specificity of this population, without forgetting the current knowledge on adult non-pregnant patients, which has to be applied to improve the quality of the care process.
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Affiliation(s)
- Simone Di Filippo
- Department of Biotechnology and Sciences of Life, Anesthesia and Intensive Care, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Daniel Agustin Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina
- Intensive Care, Hospital Carlos Malbran, Catamarca, Argentina
| | - Marina Manca
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Camilla Paolessi
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Federico Bilotta
- Department of Anesthesiology, University of Rome “Sapienza”, Rome, Italy
| | - Ainhoa Meseguer
- Department of Obstetrics, Hospital Francesc de Borja, Gandia, Spain
| | - Paolo Severgnini
- Department of Biotechnology and Sciences of Life, Anesthesia and Intensive Care, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Universitat de València, Valencia, Spain
| | - Chiara Robba
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
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10
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Steele JW, Lin YL, Chen N, Wlodarczyk BJ, Chen Q, Attarwala N, Venkatesalu M, Cabrera RM, Gross SS, Finnell RH. Embryonic Hypotaurine Levels Contribute to Strain-Dependent Susceptibility in Mouse Models of Valproate-Induced Neural Tube Defects. Front Cell Dev Biol 2022; 10:832492. [PMID: 35265619 PMCID: PMC8898900 DOI: 10.3389/fcell.2022.832492] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/21/2022] [Indexed: 01/24/2023] Open
Abstract
Valproic acid (VPA, valproate, Depakote) is a commonly used anti-seizure medication (ASM) in the treatment of epilepsy and a variety of other neurological disorders. While VPA and other ASMs are efficacious for management of seizures, they also increase the risk for adverse pregnancy outcomes, including neural tube defects (NTDs). Thus, the utility of these drugs during pregnancy and in women of childbearing potential presents a continuing public health challenge. Elucidating the underlying genetic or metabolic risk factors for VPA-affected pregnancies may lead to development of non-teratogenic ASMs, novel prevention strategies, or more targeted methods for managing epileptic pregnancies. To address this challenge, we performed unbiased, whole embryo metabolomic screening of E8.5 mouse embryos from two inbred strains with differential susceptibility to VPA-induced NTDs. We identified metabolites of differential abundance between the two strains, both in response to VPA exposure and in the vehicle controls. Notable enriched pathways included lipid metabolism, carnitine metabolism, and several amino acid pathways, especially cysteine and methionine metabolism. There also was increased abundance of ω-oxidation products of VPA in the more NTD-sensitive strain, suggesting differential metabolism of the drug. Finally, we found significantly reduced levels of hypotaurine in the susceptible strain regardless of VPA status. Based on this information, we hypothesized that maternal supplementation with L-carnitine (400 mg/kg), coenzyme A (200 mg/kg), or hypotaurine (350 mg/kg) would reduce VPA-induced NTDs in the sensitive strain and found that administration of hypotaurine prior to VPA exposure significantly reduced the occurrence of NTDs by close to one-third compared to controls. L-carnitine and coenzyme A reduced resorption rates but did not significantly reduce NTD risk in the sensitive strain. These results suggest that genetic variants or environmental exposures influencing embryonic hypotaurine status may be factors in determining risk for adverse pregnancy outcomes when managing the health care needs of pregnant women exposed to VPA or other ASMs.
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Affiliation(s)
- John W. Steele
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Ying Linda Lin
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Nellie Chen
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
- Department of BioSciences, Rice University, Houston, TX, United States
| | - Bogdan J. Wlodarczyk
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Qiuying Chen
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, United States
| | - Nabeel Attarwala
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, United States
| | - Madhu Venkatesalu
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
- Department of BioSciences, Rice University, Houston, TX, United States
| | - Robert M. Cabrera
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Steven S. Gross
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, United States
| | - Richard H. Finnell
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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11
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Battistoni M, Bacchetta R, Di Renzo F, Metruccio F, Moretto A, Menegola E. Modified Xenopus laevis approach (R-FETAX) as an alternative test for the evaluation of foetal valproate spectrum disorder. Reprod Toxicol 2021; 107:140-149. [PMID: 34923091 DOI: 10.1016/j.reprotox.2021.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
In compliance to animal welfare 3Rs principle there is a great demand for refined tests alternative to classical mammal teratogenicity tests. We propose a refined alternative amphibian method (R-FETAX) to evaluate chemical induced embryotoxicity. The human foetal valproate spectrum disorder (FVSD) characteristics are morphological defects (including cranio-facial, neural tube defects) and behavioural alterations due to valproate (VPA) exposure in pregnancy. Vertebrate assays to evaluate FVSD include classical and alternative mammal (implying adult sacrifice), and non-mammal developmental models (zebrafish, amphibians, chick). Among these latter only zebrafish assays report in the same test both morphological and behavioural examinations. Compared to zebrafish, the amphibian Xenopus laevis excels having a more comparable organ development and morphology to mammalian systems. We used X. laevis embryos exposed during developmental specific windows to VPA therapeutic concentrations. Different VPA effects were observed depending on the exposure window: concentration-related embryo-lethal and teratogenic effects (neural tube, facial, tail defects) were observed in groups exposed at the organogenetic phylotypic stages. Neurobehavioral deficits were described using a functional swimming test at the highest VPA concentration exposure during the phylotypic stages and at any concentration during neurocognitive competent stages. Malformations were compared to those obtained in a mammalian assay (the rat post-implantation whole embryo culture method, WEC), that we used in the past to evaluate VPA teratogenicity. R-FETAX and WEC data were modelled and their relative sensitivity was calculated. We suggest the amphibian R-FETAX as a refined windowed alternative test for the evaluation of chemicals inducing both morphological and behavioural anomalies, including VPA.
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Affiliation(s)
- Maria Battistoni
- Università Degli Studi di Milano, Department of Physics Aldo Pontremoli, via Celoria, 16-20133, Milan, Italy; Università Degli Studi di Milano, Department of Environmental Science and Policy, via Celoria, 26-20133, Milan, Italy.
| | - Renato Bacchetta
- Università Degli Studi di Milano, Department of Environmental Science and Policy, via Celoria, 26-20133, Milan, Italy.
| | - Francesca Di Renzo
- Università Degli Studi di Milano, Department of Environmental Science and Policy, via Celoria, 26-20133, Milan, Italy.
| | | | - Angelo Moretto
- Università Degli Studi di Milano, Department of Biomedical and Clinical Sciences "L. Sacco", via GB Grassi, 74- 20159, Milan, Italy.
| | - Elena Menegola
- Università Degli Studi di Milano, Department of Environmental Science and Policy, via Celoria, 26-20133, Milan, Italy.
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12
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Yacob A, Carr CJ, Foote J, Scullen T, Werner C, Mathkour M, Bui CJ, Dumont AS. The Global Burden of Neural Tube Defects and Disparities in Neurosurgical Care. World Neurosurg 2021; 149:e803-e820. [PMID: 33540098 DOI: 10.1016/j.wneu.2021.01.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite the success of folic acid fortification programs, neural tube defects (NTDs) such as spina bifida, encephalocele, and anencephaly remain among the most substantial causes of childhood morbidity and mortality worldwide. Although these are complicated conditions that require an interdisciplinary approach to care, definitive treatment of survivable NTDs is often neurosurgical. METHODS Using Global Burden of Disease data, we examined the global burden of NTDs as related to a nation's wealth, health care quality, and access to neurosurgical care. We abstracted data for death by cause, years lived with disability (YLD), gross domestic product (GDP), United Nations geoscheme, Food Fortification Initiative participation, and Healthcare Access and Quality Index. We compared means using 1-way analysis of variance and proportions using Fisher exact tests, with statistical significance as α = 0.05. RESULTS Seventeen of 20 (85%) nations with the most deaths caused by NTDs (P < 0.0001) and 15/20 (75%) nations with the highest YLD (P < 0.0001) were in the lowest GDP quartile. Deaths and YLD were negatively correlated with increasing GDP and Healthcare Access and Quality Index (P < 0.0001). The nations with the highest disease burdens also had the fewest neurosurgeons per capita. CONCLUSIONS Despite the success of folic acid fortification programs, greater global public health efforts should be placed on improving access to neurosurgical care in low and middle-income nations through sustainable initiatives such as surgeon exchange programs and the establishment of neurosurgery residency training programs.
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Affiliation(s)
- Alex Yacob
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Christopher J Carr
- Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center, New Orleans, Louisiana, USA.
| | - Jake Foote
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tyler Scullen
- Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center, New Orleans, Louisiana, USA
| | - Cassidy Werner
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center, New Orleans, Louisiana, USA
| | - Cuong J Bui
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University Medical Center, New Orleans, Louisiana, USA
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13
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Albright P, Veenstra J, Habeck J, Bovid K. Lower Extremity Surgical Treatment to Improve Function in a Patient with Gollop-Wolfgang Complex: A Case Report. JBJS Case Connect 2020; 9:e0254. [PMID: 31211748 DOI: 10.2106/jbjs.cc.18.00254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Gollop-Wolfgang Complex (GWC) includes congenital absence of the tibia with ipsilateral distal femur bifurcation associated with hand/foot ectrodactyly. A 20-month-old male presented with GWC, including left bifid distal femur with ipsilateral tibial hemimelia and absent extensor mechanism, hypoplastic bilateral thumbs, and right foot tarsal-type preaxial polydactyly. Left through-knee amputation preserving growth and contralateral polydactyly reconstruction were performed. Complications of wound infection and dehiscence were successfully treated. Patient is 44 months old and ambulating with left knee disarticulation prosthesis and right supramalleolar orthosis. CONCLUSIONS Through-knee amputation and prosthetic fitting provides limb function for GWC patients with tibial hemimelia lacking an extensor mechanism.
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Affiliation(s)
- Patrick Albright
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Joshua Veenstra
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Jason Habeck
- Watertown Regional Medical Center, Watertown, Wisconsin
| | - Karen Bovid
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
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14
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Bouazza N, Foissac F, Hirt D, Urien S, Benaboud S, Lui G, Treluyer JM. Methodological Approaches to Evaluate Fetal Drug Exposure. Curr Pharm Des 2020; 25:496-504. [PMID: 30892158 DOI: 10.2174/1381612825666190319102812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/16/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Drug prescriptions are usual during pregnancy, however, women and their fetuses still remain an orphan population with regard to drugs efficacy and safety. Most xenobiotics diffuse through the placenta and some of them can alter fetus development resulting in structural abnormalities, growth or functional deficiencies. METHODS To summarize the different methodologies developed towards the prediction of fetal drug exposure. RESULTS Neonatal cord blood concentration is the most specific measurement of the transplacental drug transfer at the end of pregnancy. Using the cord blood and mother drug concentrations altogether, drug exchanges between the mother and fetus can be modeled and quantified via a population pharmacokinetic analysis. Thereafter, it is possible to estimate the fetus exposure and the fetus-to-mother exposure ratio. However, the prediction of placental transfer before any administration to pregnant women is desirable. Animal studies remain difficult to interpret due to structural and functional inter-species placenta differences. The ex-vivo perfusion of the human placental cotyledon is the method of reference to study the human placental transfer of drugs because it is thought to mimic the functional placental tissue. However, extrapolation of data to in vivo situation remains difficult. Some research groups have extensively worked on physiologically based models (PBPK) to predict fetal drug exposure and showed very encouraging results. CONCLUSION PBPK models appeared to be a very promising tool in order to predict fetal drug exposure in-silico. However, these models mainly picture the end of pregnancy and knowledge regarding both, development of the placental permeability and transporters is strongly needed.
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Affiliation(s)
- Naïm Bouazza
- Universite Paris Descartes, EA7323, Sorbonne Paris Cite, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - Frantz Foissac
- Universite Paris Descartes, EA7323, Sorbonne Paris Cite, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - Déborah Hirt
- Universite Paris Descartes, EA7323, Sorbonne Paris Cite, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Saïk Urien
- Universite Paris Descartes, EA7323, Sorbonne Paris Cite, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - Sihem Benaboud
- Universite Paris Descartes, EA7323, Sorbonne Paris Cite, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Gabrielle Lui
- Universite Paris Descartes, EA7323, Sorbonne Paris Cite, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Jean-Marc Treluyer
- Universite Paris Descartes, EA7323, Sorbonne Paris Cite, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
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15
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Tominey S, Kaliaperumal C, Gallo P. External validation of a new classification of spinal lipomas based on embryonic stage. J Neurosurg Pediatr 2020; 25:394-401. [PMID: 31978883 DOI: 10.3171/2019.11.peds19575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/15/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Contention exists regarding appropriate classification and management of spinal lipomas (SLs). Given the heterogeneity of SLs, omissions and overlap between surgically incomparable groups exist in conventional classification systems. The new classification of spinal lipoma (NCSL) recently proposed by Morota et al. delineates morphology by embryological pathogenesis and the resultant operative difficulty. Here, the authors aimed to validate the NCSL by applying it to patients who had been operated on at their institution. METHODS All children who had undergone resection for SL between 2014 and 2018 were included in this analysis. MRI studies were independently reviewed and classified by three adjudicators. Baseline characteristics, inter-adjudicator agreement, coexisting anomalies and/or malformations, and postoperative outcomes and complications were analyzed. RESULTS Thirty-six patients underwent surgical untethering for SL: NCSL type 1 in 5 patients (14%), type 2 in 14 patients (39%), type 3 in 4 patients (11%), and type 4 in 13 patients (36%). All classification was agreed on first assignment by the adjudicators. Radical or near-radical resection, which was attempted in all patients, was always possible in those with type 1 and 4 SL, but never in those with type 2 and 3 SL. Neurological stabilization and/or improvement were observed in all patients at the last follow-up. CONCLUSIONS The NCSL was found to be a logical and reproducible system to apply in this SL population. All cases were successfully classified with a high degree of inter-assessor agreement. Widespread establishment of a commonly adopted and clinically useful classification system will enable clinicians to improve patient selection as well as discussion with patient representatives during the decision-making process.
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Affiliation(s)
| | | | - Pasquale Gallo
- 2Department of Pediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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16
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Gholami M, Jafari F, Baradaran Z, Amri J, Azhdari-Zarmehri H, Sadegh M. Effects of aqueous extract of Hyssopus officinalis on seizures induced by pentylenetetrazole and hippocampus mRNA level of iNOS in rats. AVICENNA JOURNAL OF PHYTOMEDICINE 2020; 10:213-221. [PMID: 32523876 PMCID: PMC7256281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We examined the effectiveness of Hyssopus officinalis (hyssop) aqueous extract on pentylenetetrazole (PTZ)-induced acute seizures and the hippocampus iNOS (inducible nitric oxide synthases) gene expression as a potential mediator of the effects. MATERIALS AND METHODS Adult male Wistar rats were used. Tonic-clonic seizures were induced by intraperitoneal (i.p.) injection of PTZ (80 mg/kg) then behavioral profile during 30 min was characterized by stages defined as seizure scores. Hyssop extract were prepared and injected (i.p.) 15 minutes before the seizure induction at three doses 50, 100 and 200 mg/kg. Experimental groups were as below: (1) saline+PTZ (n=5); (2) Hyssop 50mg/kg+PTZ (n=10); (3) Hyssop 100mg/kg+PTZ (n=10); (4) Hyssop 200 mg/kg+PTZ (n=8). Two hours after the experimental procedure, all animals were decapitated, brain was removed and right hippocampus was quickly dissected. After total RNA extraction and cDNA synthesis quantitative PCR were used for gene expression of iNOS. RESULTS Our results showed significant increase (p<0.05) in latency to reach stages 5 and 6 of tonic-clonic seizure at dose 100 mg/kg hyssop extract. In addition, this dose caused significant increase in the gene expression of iNOS in the hippocampus. CONCLUSION It seems a 100 mg/kg dose of hyssop extract might have anticonvulsant effects. However, these anticonvulsant effects might not occur through the iNOS gene expression.
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Affiliation(s)
- Masoumeh Gholami
- Neuroscience Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.,Department of Physiology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Faranak Jafari
- Neuroscience Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.,Department of Physiology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Zahra Baradaran
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Jamal Amri
- Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran.
| | - Hassan Azhdari-Zarmehri
- Neuroscience Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.,Department of Physiology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Mehdi Sadegh
- Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran.,Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran. ,Corresponding Author: Tel: +98-8634173502(352), Fax: +98-8634173521,
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17
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Massa V, Avagliano L, Grazioli P, De Castro SCP, Parodi C, Savery D, Vergani P, Cuttin S, Doi P, Bulfamante G, Copp AJ, Greene NDE. Dynamic acetylation profile during mammalian neurulation. Birth Defects Res 2019; 112:205-211. [PMID: 31758757 PMCID: PMC7004172 DOI: 10.1002/bdr2.1618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/25/2019] [Accepted: 11/03/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Neural tube defects (NTDs) result from failure of neural tube closure during embryogenesis. These severe birth defects of the central nervous system include anencephaly and spina bifida, and affect 0.5-2 per 1,000 pregnancies worldwide in humans. It has been demonstrated that acetylation plays a pivotal role during neural tube closure, as animal models for defective histone acetyltransferase proteins display NTDs. Acetylation represents an important component of the complex network of posttranslational regulatory interactions, suggesting a possible fundamental role during primary neurulation events. This study aimed to assess protein acetylation contribution to early patterning of the central nervous system both in human and murine specimens. METHODS We used both human and mouse (Cited2 -/- ) samples to analyze the dynamic acetylation of proteins during embryo development through immunohistochemistry, western blot analysis and quantitative polymerase chain reaction. RESULTS We report the dynamic profile of histone and protein acetylation status during neural tube closure. We also report a rescue effect in an animal model by chemical p53 inhibition. CONCLUSIONS Our data suggest that the p53-acetylation equilibrium may play a role in primary neurulation in mammals.
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Affiliation(s)
- Valentina Massa
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Laura Avagliano
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Paolo Grazioli
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Sandra C P De Castro
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Chiara Parodi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Dawn Savery
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Patrizia Vergani
- Department of Obstetrics and Gynaecology, Foundation MBBM, University of Milano-Bicocca, Monza, Italy
| | - Serena Cuttin
- Department of Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Patrizia Doi
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Andrew J Copp
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Nicholas D E Greene
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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18
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Anmella G, Pacchiarotti I, Cubała WJ, Dudek D, Maina G, Thomas P, Vieta E. Expert advice on the management of valproate in women with bipolar disorder at childbearing age. Eur Neuropsychopharmacol 2019; 29:1199-1212. [PMID: 31590972 DOI: 10.1016/j.euroneuro.2019.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/30/2019] [Accepted: 09/13/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The perinatal period is associated with up to 2/3 relapses in untreated bipolar disorder (BD), with important consequences on the clinical BD outcome and on fetal and child development. Valproate (VPA), one of the most effective treatments in BD, is associated with the highest risk of serious neurodevelopmental disorders in exposed children. This has brought to tightened restrictions to its use by regulatory agencies and clinical guidelines. METHODS A panel of experts on the pharmacological treatment of BD conducted a non-systematic review of the scientific literature and clinical guidelines until March 2019, and provided specific evidence-based and experience-based clinical recommendations for VPA switching/discontinuation in BD women of childbearing potential. RESULTS After the review of the evidence in a face-to-face meeting, the panel concluded that several clinical criteria need to be considered to make a clinical decision about VPA discontinuation and switch. The plateau cross-taper switch may be preferred. Abrupt switching may bear augmented risk of relapse CONCLUSIONS: BD childbearing women treated with VPA must be managed on a personalized basis according to the clinical situation. It is mandatory to stop VPA during pregnancy. The duration of the discontinuation/switch process depends on different clinical variables. Lithium, lamotrigine, quetiapine, olanzapine or aripiprazole are good options for switch in stable BD patients in planned/unplanned pregnancy. In unstable BD patients planning pregnancy, stability is paramount. Prevention of post-partum episodes requires reinstatement of effective treatment before or after birth (in the case of VPA). VPA is still an option in the post-partum period and beyond.
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Affiliation(s)
- Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Wiesław Jerzy Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 7 Dębinki St., 80-952 Gdańsk, Poland
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonien University Collegium Medicum, Kopernika 21a st, 31-501 Cracow, Poland
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy and San Luigi Gonzaga University Hospital
| | - Pierre Thomas
- University Lille, CNRS UMR 9193-PsyCHIC-SCALab, and CHU Lille, Pôle de Psychiatrie, F-59000 Lille, France
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain.
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Philbrook NA, Nikolovska A, Maciver RD, Belanger CL, Winn LM. Characterizing the effects of in utero exposure to valproic acid on murine fetal heart development. Birth Defects Res 2019; 111:1551-1560. [PMID: 31661193 DOI: 10.1002/bdr2.1610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, the use of the antiepileptic drug valproic acid (VPA) for the treatment of psychiatric conditions has been on the rise. However, studies have shown that in utero VPA exposure can affect embryonic development, including being associated with congenital heart defects. One proposed mechanism of VPA-initiated teratogenicity is the inhibition of histone deacetylase, which is involved in the regulation of transcription factors that regulate cardiogenesis. Myocyte enhancing factor 2C (Mef2c), a transcription factor involved in the development of cardiac structure and cardiomyocyte differentiation, has been shown to increase in response to in utero VPA exposure, associating with contractile dysfunction and myocardial disorganization. METHODS To characterize the effects of VPA on murine heart development, pregnant CD-1 mice were dosed with 400 mg/kg of VPA on gestational day (GD) 9. Using high-resolution ultrasound, we examined the effects of VPA on cardiac contractile function on GD 14-18, with fetal hearts being harvested on GD 19 for histological analysis. Lastly, we conducted quantitative real-time polymerase chain reaction to measure the relative Mef2c gene expression in GD 16 murine hearts. RESULTS We observed structural anomalies at GD 19 in the hearts of VPA-treated mice. Additionally, our results showed alterations in measures of cardiac contractility, with a decrease or increase in cardiac contractile ability in VPA-treated mice depending on the GD and measurement taken. CONCLUSIONS These results further characterize the effects of VPA on heart development and suggest that alterations in Mef2c gene expression, at least on GD 16, do not mediate VPA-induced cardiotoxicity in CD-1 mice.
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Affiliation(s)
| | | | | | | | - Louise M Winn
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,School of Environmental Studies, Queen's University, Kingston, Ontario, Canada
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Khuda I, Aljaafari D. Epilepsy in pregnancy. A comprehensive literature review and suggestions for saudi practitioners. ACTA ACUST UNITED AC 2019; 23:185-193. [PMID: 30007993 PMCID: PMC8015586 DOI: 10.17712/nsj.2018.3.20180129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the context of local culture and misconceptions regarding epilepsy, Saudi practitioners need a careful management plan for women with epilepsy that satisfies all the patients’ needs and ensures their spouses’ understanding. Such a management strategy needs to incorporate careful selection and monitoring of anti-epileptic drugs and regular counseling of patients. Female epileptic patients in the reproductive age group, no matter whether they are pregnant or not, should be managed by safest drugs from the earliest with folic acid supplementation along with adequate pre-marriage/conception counseling. All antiepileptic drugs are potentially teratogenic. However, valproic acid, phenytoin, phenobarbitone, and topiramate are least favored for use. Monotherapy is preferred over polytherapy, and the least possible dose should be used. During pregnancy, many epileptic women may need monthly drug level monitoring and dose readjustments. Normal vaginal delivery is safe in epileptic women. Post-partum follow-up with anti-epileptic drug titration may be required.
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Affiliation(s)
- Inam Khuda
- Department of Neurology, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Al-Khobar, Kingdom of Saudi Arabia. E-mail:
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Tobin M, Gunaji R, Walsh JC, Grice GP. A review of genetic factors underlying craniorachischisis and omphalocele: Inspired by a unique trisomy 18 case. Am J Med Genet A 2019; 179:1642-1651. [PMID: 31184807 DOI: 10.1002/ajmg.a.61255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 11/11/2022]
Abstract
Very few cases of craniorachischisis (CRN) with concomitant omphalocele (OMP) in the setting of trisomy 18 are reported in literature. Solitary midline closure defects are estimated to be more prevalent in trisomy 18 compared to the general population. Neurulation defect comparisons include anencephaly 0-2% versus 0.0206%, spina bifida 1-3% versus 0.0350%, and encephalocele 0-2% versus 0.0082% [Parker et al. (2010); Birth Defects Research. Part A: Clinical and Molecular Teratology, 88:1008-1016; Springett et al. (2015); American Journal of Medical Genetics. Part A, 167A:3062-3069]. The solitary anterior malformation OMP has been reported as high as 6% with trisomy 18 [Springett et al. (2015); American Journal of Medical Genetics. Part A, 167A:3062-3069]. We report the third published case of CRN with concomitant OMP observed in a likely trisomy 18 fetus that screened positive by noninvasive prenatal screening. Furthermore, we review and analyze the current literature to augment understanding of the genetic basis for anterior and posterior closure defects such as CRN and OMP. Although the current genetic lexicon lacks any definitive association with the simultaneous defects presented, previous research elucidated various genes related to anterior or posterior closure interruption individually. By consolidating current research, the authors advance knowledge of interconnected genetic pathology and direct future genetic mapping efforts.
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Affiliation(s)
- Michael Tobin
- CPT, Medical Corps, US Army, PGY-1 Emergency Medicine Resident, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Rajesh Gunaji
- LT, Medical Corps, US Navy, F. Edward Hébert School of Medicine, Class of 2019, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - John C Walsh
- Laboratory Department, LCDR, Medical Corps (FS), US Navy, PGY-5 Pathology Resident, Naval Medical Center, San Diego, California
| | - Guerard P Grice
- Laboratory Department, CAPT (Ret.), Medical Corps, US Navy, Naval Medical Center, San Diego, California
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22
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Joung WJ. Pregnancy and Childbirth Experiences of Women with Epilepsy: A Phenomenological Approach. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 13:122-129. [PMID: 30872036 DOI: 10.1016/j.anr.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 01/21/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study sought to understand and describe the pregnancy and childbirth experiences of women with epilepsy (WWE). METHODS Data were collected from 2016-2017 through in-depth individual interviews with 12 WWE who experienced childbirth within 36 months. Verbatim transcripts were analyzed following Colaizzi's phenomenological analysis to uncover the meaning of the experiences of the participants. RESULTS The pregnancy and childbirth experiences of WWE were clustered into four theme clusters and 8 themes from 20 meaning units: 1) Feeling anxious due to unplanned pregnancy and unexpected changes; 2) Standing at crossroads that never guarantee satisfaction; 3) Carrying a burden of fearful expectation and daily routines; 4) Enjoying rewards of pregnancy and childbirth as a woman with epilepsy. CONCLUSION WWE had strong anxiety about the possible abnormality of their babies during pregnancy. They had mixed feelings about delivery and had to make a tough decision about breastfeeding because of antiepileptic drugs use. After childbirth, they had increased fear about the possible inheritance of the illness and had a hard time managing the burden of childcare and seizure control. However, pregnancy allows these women to gain disease awareness and further appreciate the importance of their health. The study results indicate the need for multidisciplinary intervention for WWE, before, during, and after pregnancy to increase communication with health professionals. Especially, preconception counselling and education led by nurses are required.
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Affiliation(s)
- Woo Joung Joung
- College of Nursing, Kyungpook National University, Daegu, Republic of Korea.
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Wang W, Gao Y, Zheng W, Li M, Zheng X. Phenobarbital inhibits osteoclast differentiation and function through NF-κB and MAPKs signaling pathway. Int Immunopharmacol 2019; 69:118-125. [PMID: 30703706 DOI: 10.1016/j.intimp.2019.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/05/2019] [Accepted: 01/22/2019] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to determine the direct effects of phenobarbital (PB) on receptor activator of nuclear factor kappa-B ligand (RANKL) induced osteoclast differentiation and function in vitro and in vivo. Here, PB significantly inhibited osteoclast formation and bone resorption ability induced by RANKL in vitro. Meanwhile, intracellular signaling transduction analysis revealed PB specifically decreasing the phosphorylation level of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and mitogen-activated protein kinase (MAPK), respectively. Besides, oral administration of PB at the dose of 60 mg/kg/day for 6 weeks led to improve the bone loss and to decrease the activity on both osteoblast and osteoclast. This suppression effect is more obvious in osteoblast-induced bone formation than that on osteoclast-induced bone resorption. Taken together, our findings demonstrated that PB down-regulate osteoclast differentiation and activity through modulation of NF-κB and MAPKs signaling pathway. The direct suppression effect on osteoclast can induce bone loss after long term oral administration. This bone loss is due to reducing bone turnover rate on both sides of bone formation and bone resorption.
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Affiliation(s)
- Wei Wang
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China; School of Public Health, Shandong University, Jinan, China
| | - Yuan Gao
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China
| | - Wenwen Zheng
- School of Public Health, Shandong University, Jinan, China
| | - Minqi Li
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China.
| | - Xuexing Zheng
- School of Public Health, Shandong University, Jinan, China.
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Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rössler A, Soyka M, Yonkers K, Yonkers K. WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 2019; 20:17-50. [PMID: 30632868 DOI: 10.1080/15622975.2018.1510185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.
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Affiliation(s)
- Florence Thibaut
- a University Hospital Cochin , Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry and Neurosciences , Paris , France
| | - Abdeslam Chagraoui
- b Neuronal and Neuroendocrine Differentiation and Communication Laboratory , Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Normandie Univ , UNIROUEN, INSERM, U1239, CHU Rouen , Rouen , France ; Department of Medical Biochemistry , Rouen University Hospital , Rouen , France
| | - Leslie Buckley
- c Addiction Services , University Health Network, University of Toronto , Toronto , Canada
| | - Florence Gressier
- d Department of Psychiatry , INSERM UMR1178 CESP, Univ. Paris-Sud , Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre , Le Kremlin Bicêtre , France
| | - Javier Labad
- e Department of Mental Health , Parc Tauli Hospital Universitari, I3PT ; Department of Psychiatry and Legal Medicine , Universitat Autonoma de Barcelona, CIBERSAM, Sabadell , Barcelona , Spain
| | - Sandrine Lamy
- f Department of Addictology , Ramsay- General de Santé, SSR Petit Colmoulins , Harfleur , France
| | - Marc N Potenza
- g Neuroscience and Child Study , Yale University School of Medicine , New Haven , CT , USA
| | - Marta Rondon
- h Instituto Nacional Materno Perinatal , Lima , Peru
| | - Anita Riecher-Rössler
- i Center for Gender Research and Early Detection , University of Basel Psychiatric Hospital , Basel , Switzerland
| | - Michael Soyka
- j University of Munich , Munich, and Medicalpark Chiemseeblick, Bernau , Germany
| | - Kim Yonkers
- k Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences , Yale University , New Haven , CT , USA
| | - Kim Yonkers
- Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
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Vajda FJE, Graham JE, Hitchcock AA, Lander CM, O'Brien TJ, Eadie MJ. Antiepileptic drugs and foetal malformation: analysis of 20 years of data in a pregnancy register. Seizure 2018; 65:6-11. [PMID: 30593875 DOI: 10.1016/j.seizure.2018.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE This paper reports additional data supplementing earlier publications based on Australian Pregnancy Register (APR) data. METHOD Over 20 years, the APR has collected Information on pregnancies in Australian women with epilepsy (WWE), untreated WWE and those taking AEDs for other indications. Contact is by telephone, at set intervals. Treatment is not interfered with. Data are analysed using conventional statistical techniques, confidence interval methods, and logistic regression. RESULTS By 2018, the APR contained details of 2148 pregnancies. AEDs were taken throughout 1972 of the pregnancies (91.8%). The remaining 176 (8.2%) did not receive AEDs, at least early in pregnancy. There were (i) dose-related increased incidences of pregnancies carrying foetal malformations associated with maternal intake of valproate and topiramate when topiramate was a component of AED polytherapy (P < .05), (ii) a similar dose-related trend in relation to carbamazepine intake, (iii) no evidence that levetiracetam and lamotrigine were unsafe from the foetal standpoint, (iv) insufficient data to permit conclusions regarding teratogenicity in relation to other AEDs, and (v) no evidence that pre-conception folate supplementation reduced the hazard of AED-associated foetal malformation. AED polytherapy did not increase foetal hazard unless valproate or topiramate was involved in the AED combination. Genetic factors probably contributed to the malformation hazard. Seizures occurring in earlier pregnancy probably did not contribute to the malformation hazard. CONCLUSIONS If it were not for the importance of maintaining seizure control, the above findings suggest that it would be better to avoid using certain AEDs, particularly valproate and topiramate, during pregnancy.
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Affiliation(s)
- F J E Vajda
- Department of Medicine and Neurosciences, Royal Melbourne Hospital University of Melbourne, Parkville, 3050 Victoria, Australia.
| | - J E Graham
- Department of Medicine and Neurosciences, Royal Melbourne Hospital University of Melbourne, Parkville, 3050 Victoria, Australia
| | - A A Hitchcock
- Department of Medicine and Neurosciences, Royal Melbourne Hospital University of Melbourne, Parkville, 3050 Victoria, Australia
| | - C M Lander
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, Queensland, 4027 Australia
| | - T J O'Brien
- Department of Medicine and Neurosciences, Alfred Hospital and Monash University, Melbourne 3004, Australia
| | - M J Eadie
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, Queensland, 4027 Australia
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26
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Sen A, Nashef L. New regulations to cut valproate-exposed pregnancies. Lancet 2018; 392:458-460. [PMID: 30129447 DOI: 10.1016/s0140-6736(18)31672-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/18/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, NIHR Oxford Biomedical Research Centre, Department of Neurology, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | - Lina Nashef
- Department of Neurology, King's College Hospital, London, UK
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27
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Eadie MJ. The management of epilepsy during pregnancy. FUTURE NEUROLOGY 2018. [DOI: 10.2217/fnl-2018-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- MJ Eadie
- Royal Brisbane & Women's Hospital Clinical School, University of Queensland, 4029, Australia
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Vajda FJE, O’Brien TJ, Graham JE, Hitchcock AA, Lander CM, Eadie MJ. Antiepileptic drug polytherapy in pregnant women with epilepsy. Acta Neurol Scand 2018; 138:115-121. [PMID: 29799623 DOI: 10.1111/ane.12965] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study seizure control and rates of foetal malformation in pregnancies of women with epilepsy treated with antiepileptic drug polytherapy. METHODS The use of conventional statistical methods to analyse the Australian Pregnancy Register records of 1810 pregnancies in women with epilepsy, 508 treated with antiepileptic drug polytherapy. RESULTS Polytherapy-treated pregnancies were less often seizure free than monotherapy-treated ones, for both focal (36.0% vs 51.9%: P < .05) and primary generalized epilepsies (41.1% vs 69.3%; P < .05). Drug combinations with dissimilar and similar mechanisms of action achieved similar rates of seizure freedom during pregnancy (36.3% vs 38.3%). The increased rate of malformed foetuses in polytherapy pregnancies depended on valproate or topiramate being in the drug combinations. The combinations of lamotrigine and levetiracetam offered the chance of seizure control and foetal safety. CONCLUSIONS In pregnancy, the use of antiepileptic drug combinations is not necessarily disadvantageous to mother and foetus if valproate and topiramate are avoided.
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Affiliation(s)
- F. J. E. Vajda
- Department of Medicine and Neurosciences; Royal Melbourne Hospital and University of Melbourne; Parkville Vic. Australia
| | - T. J. O’Brien
- Department of Medicine and Neurosciences; Royal Melbourne Hospital and University of Melbourne; Parkville Vic. Australia
| | - J. E. Graham
- Department of Medicine and Neurosciences; Royal Melbourne Hospital and University of Melbourne; Parkville Vic. Australia
| | - A. A. Hitchcock
- Department of Medicine and Neurosciences; Royal Melbourne Hospital and University of Melbourne; Parkville Vic. Australia
| | - C. M. Lander
- Royal Brisbane and Women’s Hospital and School of Medicine and Biomedical Science; University of Queensland; Brisbane QLD Australia
| | - M. J. Eadie
- Royal Brisbane and Women’s Hospital and School of Medicine and Biomedical Science; University of Queensland; Brisbane QLD Australia
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Akbarian B, Erfanian A. Automatic Seizure Detection Based on Nonlinear Dynamical Analysis of EEG Signals and Mutual Information. Basic Clin Neurosci 2018; 9:227-240. [PMID: 30519381 PMCID: PMC6276534 DOI: 10.32598/bcn.9.4.227] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/10/2017] [Accepted: 10/04/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction: In this paper, nonlinear dynamical analysis based on Recurrence Quantification Analysis (RQA) is employed to characterize the nonlinear EEG dynamics. RQA can provide useful quantitative information on the regular, chaotic, or stochastic property of the underlying dynamics. Methods: We use the RQA-based measures as the quantitative features of the nonlinear EEG dynamics. Mutual Information (MI) was used to find the most relevant feature subset out of RQA-based features. The selected features were fed into an artificial neural network for grouping of EEG recordings to detect ictal, interictal, and healthy states. The performance of the proposed procedure was evaluated using a database for different classification cases. Results: The combination of five selected features based on MI achieved 100% accuracy, which demonstrates the superiority of the proposed method. Conclusion: The results showed that the nonlinear dynamical analysis based on Rcurrence Quantification Analysis (RQA) can be employed as a suitable approach for characterizing the nonlinear EEG dynamics and detecting the seizure.
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Affiliation(s)
- Behnaz Akbarian
- Iran Neural Technology Research Centre, Iran University of Science and Technology, Tehran, Iran
| | - Abbas Erfanian
- Department of Bioelectrical Engineering, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
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Rezaallah B, Lewis DJ, Zeilhofer HF, Berg BI. Risk of Cleft Lip and/or Palate Associated With Antiepileptic Drugs: Postmarketing Safety Signal Detection and Evaluation of Information Presented to Prescribers and Patients. Ther Innov Regul Sci 2018; 53:110-119. [PMID: 29714593 DOI: 10.1177/2168479018761638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The aim was to analyze safety data associated with the maternal use of antiepileptic drugs in pregnancy and to assess the risk of cleft lip and/or palate (CL/P) as an outcome in the neonate. A parallel objective was to assess the completeness of the safety information concerning pregnancy exposures in the Summary of Product Characteristics (SmPCs) and the Patient Information (PI) in the USA and the UK. METHODS We analyzed individual case safety reports of CL/P associated with antiepileptic drugs in the FDA Adverse Event Reporting System. For the antiepileptic drugs with signals (EB05 ≥ 2), we reviewed Drug Analysis Prints for CL/P cases in the UK Medicines and Healthcare products Regulatory Agency (MHRA). We performed descriptive analyses of relevant SmPCs and PIs in the UK and the USA using a checklist of recommendations collected from the literature. RESULTS In total 817 CL/P reports were identified for 12 antiepileptic drugs in the FDA Adverse Event Reporting System. Ten of the 12 antiepileptic drugs were associated with 156 CL/P cases in the MHRA Sentinel. Safety information concerning pregnancy was found to be more comprehensive in UK SmPCs than in the US equivalents. CONCLUSIONS There is statistical disproportionality in individual case safety reports indicative of an increased risk of CL/P with 12 antiepileptic drugs studied. More studies are required to explore the association between in utero exposure to antiepileptic drugs and the risk of CL/P. There are inconsistencies between the UK and US safety labels. CL/P associated with antiepileptic drugs is an important topic and requires providing inclusive, unbiased, up-to-date information to prescribers and women of childbearing age.
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Affiliation(s)
- Bita Rezaallah
- 1 Department of Clinical Research, University of Basel, Basel, Switzerland.,2 Patient Safety, Novartis Global Drug Development, Novartis Pharma Basel, Switzerland
| | - David John Lewis
- 2 Patient Safety, Novartis Global Drug Development, Novartis Pharma Basel, Switzerland.,3 School of Health and Human Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Hans-Florian Zeilhofer
- 4 Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland.,5 Hightech Research Center of Cranio-Maxillofacial Surgery, University of Basel, Basel, Switzerland
| | - Britt-Isabelle Berg
- 4 Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland.,5 Hightech Research Center of Cranio-Maxillofacial Surgery, University of Basel, Basel, Switzerland.,6 Division of Oral and Maxillofacial Radiology, Columbia University Medical Center, New York City, NY, USA
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Illamola SM, Bucci‐Rechtweg C, Costantine MM, Tsilou E, Sherwin CM, Zajicek A. Inclusion of pregnant and breastfeeding women in research - efforts and initiatives. Br J Clin Pharmacol 2018; 84:215-222. [PMID: 28925019 PMCID: PMC5777434 DOI: 10.1111/bcp.13438] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 01/06/2023] Open
Abstract
Pregnant and breastfeeding women have been rendered therapeutic orphans as they have been historically excluded from clinical trials. Labelling for most approved drugs does not provide information about safety and efficacy during pregnancy. This lack of data is mainly due to ethico-legal challenges that have remained entrenched in the post-diethylstilbestrol and thalidomide era, and that have led to pregnancy being viewed in the clinical trial setting primarily through a pharmacovigilance lens. Policy considerations that encourage and/or require the inclusion of pregnant or lactating women in clinical trials may address the current lack of available information. However, there are additional pragmatic strategies, such the employment of pharmacometric tools and the introduction of innovative clinical trial designs, which could improve knowledge about the safety and efficacy of medication use during pregnancy and lactation. This paper provides a broad overview of the pharmacoepidemiology of drugs used during pregnancy and lactation, and offers recommendations for regulators and researchers in academia and industry to increase the available pharmacokinetic and -dynamic understanding of medication use in pregnancy.
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Affiliation(s)
- Sílvia M. Illamola
- Division of Clinical Pharmacology, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | - Christina Bucci‐Rechtweg
- Pediatric & Maternal Health Policy, Global Drug Regulatory AffairsNovartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineUniversity of Texas Medical BranchGalvestonTXUSA
| | - Ekaterini Tsilou
- Obstetric and Pediatric Pharmacology and Therapeutics Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMDUSA
| | - Catherine M. Sherwin
- Division of Clinical Pharmacology, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUTUSA
- Department of PharmacotherapyUniversity of Utah College of PharmacySalt Lake CityUTUSA
| | - Anne Zajicek
- Obstetric and Pediatric Pharmacology and Therapeutics Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMDUSA
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Blencowe H, Kancherla V, Moorthie S, Darlison MW, Modell B. Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Ann N Y Acad Sci 2018; 1414:31-46. [PMID: 29363759 DOI: 10.1111/nyas.13548] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 12/19/2022]
Abstract
Neural tube defects (NTDs) are associated with substantial mortality, morbidity, disability, and psychological and economic costs. Many are preventable with folic acid, and access to appropriate services for those affected can improve survival and quality of life. We used a compartmental model to estimate global and regional birth prevalence of NTDs (live births, stillbirths, and elective terminations of pregnancy) and subsequent under-5 mortality. Data were identified through web-based reviews of birth defect registry databases and systematic literature reviews. Meta-analyses were undertaken where appropriate. For 2015, our model estimated 260,100 (uncertainty interval (UI): 213,800-322,000) NTD-affected birth outcomes worldwide (prevalence 18.6 (15.3-23.0)/10,000 live births). Approximately 50% of cases were elective terminations of pregnancy for fetal anomalies (UI: 59,300 (47,900-74,500)) or stillbirths (57,800 (UI: 35,000-88,600)). Of NTD-affected live births, 117,900 (∼75%) (UI: 105,500-186,600) resulted in under-5 deaths. Our systematic review showed a paucity of high-quality data in the regions of the world with the highest burden. Despite knowledge about prevention, NTDs remain highly prevalent worldwide. Lack of surveillance and incomplete ascertainment of affected pregnancies make NTDs invisible to policy makers. Improved surveillance of all adverse outcomes is needed to improve the robustness of total NTD prevalence estimation, evaluate effectiveness of prevention through folic acid fortification, and improve outcomes through care and rehabilitation.
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Affiliation(s)
- Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | - Matthew W Darlison
- World Health Organization Collaborating Centre for Community Genetics, UCL Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
| | - Bernadette Modell
- World Health Organization Collaborating Centre for Community Genetics, UCL Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
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Abduljalil K, Johnson TN, Rostami-Hodjegan A. Fetal Physiologically-Based Pharmacokinetic Models: Systems Information on Fetal Biometry and Gross Composition. Clin Pharmacokinet 2017; 57:1149-1171. [DOI: 10.1007/s40262-017-0618-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Veroniki AA, Rios P, Cogo E, Straus SE, Finkelstein Y, Kealey R, Reynen E, Soobiah C, Thavorn K, Hutton B, Hemmelgarn BR, Yazdi F, D'Souza J, MacDonald H, Tricco AC. Comparative safety of antiepileptic drugs for neurological development in children exposed during pregnancy and breast feeding: a systematic review and network meta-analysis. BMJ Open 2017; 7:e017248. [PMID: 28729328 PMCID: PMC5642793 DOI: 10.1136/bmjopen-2017-017248] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Compare the safety of antiepileptic drugs (AEDs) on neurodevelopment of infants/children exposed in utero or during breast feeding. DESIGN AND SETTING Systematic review and Bayesian random-effects network meta-analysis (NMA). MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched until 27 April 2017. Screening, data abstraction and quality appraisal were completed in duplicate by independent reviewers. PARTICIPANTS 29 cohort studies including 5100 infants/children. INTERVENTIONS Monotherapy and polytherapy AEDs including first-generation (carbamazepine, clobazam, clonazepam, ethosuximide, phenobarbital, phenytoin, primidone, valproate) and newer-generation (gabapentin, lamotrigine, levetiracetam, oxcarbazepine, topiramate, vigabatrin) AEDs. Epileptic women who did not receive AEDs during pregnancy or breast feeding served as the control group. PRIMARY AND SECONDARY OUTCOME MEASURES Cognitive developmental delay and autism/dyspraxia were primary outcomes. Attention-deficit hyperactivity disorder, language delay, neonatal seizures, psychomotor developmental delay and social impairment were secondary outcomes. RESULTS The NMA on cognitive developmental delay (11 cohort studies, 933 children, 18 treatments) suggested that among all AEDs only valproate was statistically significantly associated with more children experiencing cognitive developmental delay compared with control (OR=7.40, 95% credible interval (CrI) 3.00 to 18.46). The NMA on autism (5 cohort studies, 2551 children, 12 treatments) suggested that oxcarbazepine (OR 13.51, CrI 1.28 to 221.40), valproate (OR 17.29, 95% CrI 2.40 to 217.60), lamotrigine (OR 8.88, CrI 1.28 to 112.00) and lamotrigine+valproate (OR 132.70, CrI 7.41 to 3851.00) were associated with significantly greater odds of developing autism compared with control. The NMA on psychomotor developmental delay (11 cohort studies, 1145 children, 18 treatments) found that valproate (OR 4.16, CrI 2.04 to 8.75) and carbamazepine+phenobarbital+valproate (OR 19.12, CrI 1.49 to 337.50) were associated with significantly greater odds of psychomotor delay compared with control. CONCLUSIONS Valproate alone or combined with another AED is associated with the greatest odds of adverse neurodevelopmental outcomes compared with control. Oxcarbazepine and lamotrigine were associated with increased occurrence of autism. Counselling is advised for women considering pregnancy to tailor the safest regimen. TRIAL REGISTRATION NUMBER PROSPERO database (CRD42014008925).
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Affiliation(s)
| | - Patricia Rios
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
| | - Elise Cogo
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, 27 King’s College Circle, Toronto, Canada
| | - Yaron Finkelstein
- The Hospital for Sick Children,555 University Avenue, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences Building, Toronto, Canada
| | - Ryan Kealey
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
| | - Emily Reynen
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
| | - Charlene Soobiah
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
- Institute for Health Policy Management & Evaluation,University of Toronto, Toronto, Canada
| | - Kednapa Thavorn
- School of Epidemiology,Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
- Institute of Clinical and Evaluative Sciences (ICES uOttawa), Ottawa, Canada
| | - Brian Hutton
- School of Epidemiology,Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute,Center for Practice Changing Research, Ottawa, Canada
| | - Brenda R Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Fatemeh Yazdi
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
| | - Jennifer D'Souza
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
| | - Heather MacDonald
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute,St. Michael’s Hospital, Toronto, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Tauheed J, Sanchez-Guerra M, Lee JJ, Paul L, Ibne Hasan MOS, Quamruzzaman Q, Selhub J, Wright RO, Christiani DC, Coull BA, Baccarelli AA, Mazumdar M. Associations between post translational histone modifications, myelomeningocele risk, environmental arsenic exposure, and folate deficiency among participants in a case control study in Bangladesh. Epigenetics 2017; 12:484-491. [PMID: 28387569 DOI: 10.1080/15592294.2017.1312238] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Arsenic exposure may contribute to disease risk in humans through alterations in the epigenome. Previous studies reported that arsenic exposure is associated with changes in plasma histone concentrations. Posttranslational histone modifications have been found to differ between the brain tissue of human embryos with neural tube defects and that of controls. Our objectives were to investigate the relationships between plasma histone 3 levels, history of having an infant with myelomeningocele, biomarkers of arsenic exposure, and maternal folate deficiency. These studies took place in Bangladesh, a country with high environmental arsenic exposure through contaminated drinking water. We performed ELISA assays to investigate plasma concentration of total histone 3 (H3) and the histone modification H3K27me3. The plasma samples were collected from 85 adult women as part of a case-control study of arsenic and myelomeningocele risk in Bangladesh. We found significant associations between plasma %H3K27me3 levels and risk of myelomeningocele (P<0.05). Mothers with higher %H3K27me3 in their plasma had lower risk of having an infant with myelomeningocele (odds ratio: 0.91, 95% confidence interval: 0.84, 0.98). We also found that arsenic exposure, as estimated by arsenic concentration in toenails, was associated with lower total H3 concentrations in plasma, but only among women with folate deficiency (β = -9.99, standard error = 3.91, P=0.02). Our results suggest that %H3K27me3 in maternal plasma differs between mothers of infants with myelomeningocele and mothers of infants without myelomeningocele, and may be a marker for myelomeningocele risk. Women with folate deficiency may be more susceptible to the epigenetic effects of environmental arsenic exposure.
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Affiliation(s)
- Jannah Tauheed
- a Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Marco Sanchez-Guerra
- a Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,b Department of Developmental Neurobiology , National Institute of Perinatology , Mexico City , Mexico
| | - Jane J Lee
- a Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c Department of Neurology , Boston Children's Hospital , Boston , MA , USA
| | - Ligi Paul
- d Jean Mayer USDA Human Nutrition Research Center on Aging , Tufts University , Boston , MA , USA
| | | | | | - Jacob Selhub
- d Jean Mayer USDA Human Nutrition Research Center on Aging , Tufts University , Boston , MA , USA
| | - Robert O Wright
- f Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - David C Christiani
- a Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Brent A Coull
- g Department of Biostatistics , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Andrea A Baccarelli
- h Department of Environmental Health Sciences , Columbia Mailman School of Public Health , New York , NY , USA
| | - Maitreyi Mazumdar
- a Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c Department of Neurology , Boston Children's Hospital , Boston , MA , USA
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Greene NDE, Leung KY, Copp AJ. Inositol, neural tube closure and the prevention of neural tube defects. Birth Defects Res 2017; 109:68-80. [PMID: 27324558 PMCID: PMC5353661 DOI: 10.1002/bdra.23533] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/24/2016] [Accepted: 05/08/2016] [Indexed: 12/29/2022]
Abstract
Susceptibility to neural tube defects (NTDs), such as anencephaly and spina bifida is influenced by genetic and environmental factors including maternal nutrition. Maternal periconceptional supplementation with folic acid significantly reduces the risk of an NTD-affected pregnancy, but does not prevent all NTDs, and "folic acid non-responsive" NTDs continue to occur. Similarly, among mouse models of NTDs, some are responsive to folic acid but others are not. Among nutritional factors, inositol deficiency causes cranial NTDs in mice while supplemental inositol prevents spinal and cranial NTDs in the curly tail (Grhl3 hypomorph) mouse, rodent models of hyperglycemia or induced diabetes, and in a folate-deficiency induced NTD model. NTDs also occur in mice lacking expression of certain inositol kinases. Inositol-containing phospholipids (phosphoinositides) and soluble inositol phosphates mediate a range of functions, including intracellular signaling, interaction with cytoskeletal proteins, and regulation of membrane identity in trafficking and cell division. Myo-inositol has been trialed in humans for a range of conditions and appears safe for use in human pregnancy. In pilot studies in Italy and the United Kingdom, women took inositol together with folic acid preconceptionally, after one or more previous NTD-affected pregnancies. In nonrandomized cohorts and a randomized double-blind study in the United Kingdom, no recurrent NTDs were observed among 52 pregnancies reported to date. Larger-scale fully powered trials are needed to determine whether supplementation with inositol and folic acid would more effectively prevent NTDs than folic acid alone. Birth Defects Research 109:68-80, 2017. © 2016 The Authors Birth Defects Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Nicholas D E Greene
- Newlife Birth Defects Research Centre and Developmental Biology & Cancer Programme, Institute of Child Health, University College London, London, United Kingdom
| | - Kit-Yi Leung
- Newlife Birth Defects Research Centre and Developmental Biology & Cancer Programme, Institute of Child Health, University College London, London, United Kingdom
| | - Andrew J Copp
- Newlife Birth Defects Research Centre and Developmental Biology & Cancer Programme, Institute of Child Health, University College London, London, United Kingdom
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Jose M, Sreelatha HV, James MV, Arumughan S, Thomas SV. Teratogenic Effects of Carbamazepine in Mice. Ann Indian Acad Neurol 2017; 20:132-137. [PMID: 28615898 PMCID: PMC5470153 DOI: 10.4103/aian.aian_492_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives: The aim of this study was to determine the teratogenic effects of carbamazepine (CBZ) in BALB/c mice. Materials and Methods: Mature female and male BALB/c mice (25–30 g) were used for all experiments. After standardization of administration and dose of CBZ, animals in the CBZ-treated groups (CBZ 450 mg/kg and 600 mg/kg) were fed on medicinal diet. The dams in the control group were mated on the same day as that of the CBZ-treated dams. After cesarean section (CS), fetal viability status and weights were recorded. Gross histopathological examination of fetuses was conducted to identify alterations in morphology and external or internal organs due to in utero exposure of CBZ. Results: Out of the nine female animals (three treated on CBZ 450 mg/kg, three treated on CBZ 600 mg/kg and three controls), seven were pregnant, and two (one each from the two CBZ-treated groups) were nonpregnant. All fetuses of the control group (n = 31) and CBZ 450 mg/kg treated group (n = 24) were live, but eight out of the twenty fetuses (40%) of CBZ 600 mg/kg treated group were dead at CS. The birth weight of the fetuses antenatally exposed to CBZ was drastically reduced (0.71 ± 0.06) when compared to control fetuses (1.67 ± 0.12) (P < 0.0001). All the fetuses of the CBZ-treated groups showed stunted physical development. Conclusion: Although oral administration of CBZ to mice is a convenient model to study the effect of CBZ to pregnancy, higher oral dose was associated with increased fetal loss. Some of the fetuses exposed to CBZ demonstrated structural abnormalities and low body weight.
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Affiliation(s)
- Manna Jose
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Harikrishnan Vijayakumar Sreelatha
- Division of Laboratory Animal Science, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Manjula Valiyamattathil James
- Department of Histopathology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sabareeswaran Arumughan
- Department of Histopathology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sanjeev Varghese Thomas
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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40
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Yan Y, Cheng X, Yang RH, Li H, Chen JL, Ma ZL, Wang G, Chuai M, Yang X. Exposure to Excess Phenobarbital Negatively Influences the Osteogenesis of Chick Embryos. Front Pharmacol 2016; 7:349. [PMID: 27746734 PMCID: PMC5044464 DOI: 10.3389/fphar.2016.00349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/15/2016] [Indexed: 12/22/2022] Open
Abstract
Phenobarbital is an antiepileptic drug that is widely used to treat epilepsy in a clinical setting. However, a long term of phenobarbital administration in pregnant women may produce side effects on embryonic skeletogenesis. In this study, we aim to investigate the mechanism by which phenobarbital treatment induces developmental defects in long bones. We first determined that phenobarbital treatment decreased chondrogenesis and inhibited the proliferation of chondrocytes in chick embryos. Phenobarbital treatment also suppressed mineralization in both in vivo and in vitro long bone models. Next, we established that phenobarbital treatment delayed blood vessel invasion in a cartilage template, and this finding was supported by the down-regulation of vascular endothelial growth factor in the hypertrophic zone following phenobarbital treatment. Phenobarbital treatment inhibited tube formation and the migration of human umbilical vein endothelial cells. In addition, it impaired angiogenesis in chick yolk sac membrane model and chorioallantoic membrane model. In summary, phenobarbital exposure led to shortened lengths of long bones during embryogenesis, which might result from inhibiting mesenchyme differentiation, chondrocyte proliferation, and delaying mineralization by impairing vascular invasion.
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Affiliation(s)
- Yu Yan
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University Guangzhou, China
| | - Xin Cheng
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University Guangzhou, China
| | - Ren-Hao Yang
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University Guangzhou, China
| | - He Li
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University Guangzhou, China
| | - Jian-Long Chen
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University Guangzhou, China
| | - Zheng-Lai Ma
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University Guangzhou, China
| | - Guang Wang
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University Guangzhou, China
| | - Manli Chuai
- Division of Cell and Developmental Biology, University of Dundee Dundee, UK
| | - Xuesong Yang
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University Guangzhou, China
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Nie Q, Su B, Wei J. Neurological teratogenic effects of antiepileptic drugs during pregnancy. Exp Ther Med 2016; 12:2400-2404. [PMID: 27698740 PMCID: PMC5038337 DOI: 10.3892/etm.2016.3628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/22/2016] [Indexed: 12/21/2022] Open
Abstract
Epilepsy is one of the few neurologic disorders that requires a constant treatment during pregnancy. Epilepsy affects 0.3–0.8% of pregnant women. Prescription of antiepileptic drugs (AEDs) to pregnant women with epilepsy requires monitoring and maintaining a balance between limiting seizures and decreasing fetal exposure to the potential teratogenic effects. AEDs are also commonly used for psychiatric disorders, pain disorders, and migraines. The types of malformations that can result in fetuses exposed to AEDs include minor anomalies, major congenital malformations, intrauterine growth retardation, cognitive dysfunction, low IQ, microcephaly, and infant mortality. In the present review, we analyzed and summarized the current understanding of neurological development in fetuses that are exposed to various AEDs administered to pregnant epileptic women.
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Affiliation(s)
- Qingmei Nie
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Baohua Su
- Department of Hematology, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Jianping Wei
- Department of Emergency Neurology, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
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Prakash C, Hatters-Friedman S, Moller-Olsen C, North A. Maternal and Fetal Outcomes After Lamotrigine Use in Pregnancy: A Retrospective Analysis from an Urban Maternal Mental Health Centre in New Zealand. PSYCHOPHARMACOLOGY BULLETIN 2016; 46:63-69. [PMID: 27738382 PMCID: PMC5044470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Pregnancy is a vulnerable period for recurrence of bipolar disorder. Discontinuation of mood stabilisers during pregnancy and the postpartum period can significantly increase the risk of recurrence of bipolar disorder. Lamotrigine is an anti-epileptic drug that has been approved for the maintenance treatment of bipolar disorder. Epilepsy literature has indicated that lamotrigine has a reassuring safety profile in pregnancy but there is little information on its effectiveness and safety in pregnant women with mental disorders. METHOD We conducted a retrospective review of all pregnant women who presented to an urban maternal mental health centre in Auckland, New Zealand between 2012 and 2014 and were treated with antipsychotics and/or mood stabilisers. Pregnancy outcome, obstetric and perinatal complications, congenital malformations and maternal mental health in the postnatal period were considered. RESULTS Here, we present the outcomes in the subset of six women who were treated with lamotrigine 100-400 mg/day for the entire pregnancy. Five were diagnosed with bipolar disorder and one with major depression. Three women received additional psychotropic medication during pregnancy. No women needed psychiatric hospitalisation. All babies were live birth after 36 weeks gestation. Two babies had low birth weight and required NICU admissions. Two women required lower segment caesarean section and the other 4 were induced. A trachea-esophageal fistula was noted in one baby. Four babies who were breastfed while their mothers received uninterrupted treatment with lamotrigine, experienced no complications. DISCUSSION This naturalistic study indicates that lamotrigine can be an effective treatment option for maintenance of bipolar illness in women of childbearing age.
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Affiliation(s)
- Chandni Prakash
- Dr. Prakash, MBBS, MD (Psych), Maternal Mental Health, Auckland District Health Board, NZ. Dr. Hatters-Friedman, MD, Department of Psychological Medicine, University of Auckland, NZ. Dr. Moller-Olsen, MBChB, Registrar Psychiatry, Auckland District Health Board, NZ. Ms. North, medical student, University of Auckland, NZ
| | - Susan Hatters-Friedman
- Dr. Prakash, MBBS, MD (Psych), Maternal Mental Health, Auckland District Health Board, NZ. Dr. Hatters-Friedman, MD, Department of Psychological Medicine, University of Auckland, NZ. Dr. Moller-Olsen, MBChB, Registrar Psychiatry, Auckland District Health Board, NZ. Ms. North, medical student, University of Auckland, NZ
| | - Charmian Moller-Olsen
- Dr. Prakash, MBBS, MD (Psych), Maternal Mental Health, Auckland District Health Board, NZ. Dr. Hatters-Friedman, MD, Department of Psychological Medicine, University of Auckland, NZ. Dr. Moller-Olsen, MBChB, Registrar Psychiatry, Auckland District Health Board, NZ. Ms. North, medical student, University of Auckland, NZ
| | - Abigail North
- Dr. Prakash, MBBS, MD (Psych), Maternal Mental Health, Auckland District Health Board, NZ. Dr. Hatters-Friedman, MD, Department of Psychological Medicine, University of Auckland, NZ. Dr. Moller-Olsen, MBChB, Registrar Psychiatry, Auckland District Health Board, NZ. Ms. North, medical student, University of Auckland, NZ
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Fabris RR, Cascino TG, Mandrekar J, Marsh WR, Meyer FB, Cascino GD. Drug-resistant focal epilepsy in women of childbearing age: Reproduction and the effect of epilepsy surgery. Epilepsy Behav 2016; 60:17-20. [PMID: 27176879 DOI: 10.1016/j.yebeh.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/22/2016] [Accepted: 04/02/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Women with epilepsy (WWE) have lower birth rates than expected. The reasons for this are multifactorial and involve a complex interaction between reproductive endocrine and psychosocial factors. The effect of epilepsy surgery on reproduction in women with drug-resistant focal epilepsy has not previously been studied. METHODS Adult women of childbearing age (18-45years old) with drug-resistant focal epilepsy who had undergone a focal cortical resection between 1997 and 2008 at the Mayo Clinic in Rochester, MN were included in the study. Patients who had a history of hysterectomy or tubal ligation or who were menopausal at the time of surgery were excluded. Data on prior pregnancies and births, epilepsy history, surgical treatment, hormonal dysfunction, and socioeconomic status were obtained using a retrospective chart review. Associations between various clinical and demographic variables with changes in pregnancies and births from pre- to postsurgery were assessed using Chi-square or Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. All tests were 2-sided, and p-values less than 0.05 were considered statistically significant. All analyses were performed using SAS software version 9.2 (SAS INC, Cary NC). RESULTS One hundred and thirteen women (average age: 30.5years) were included in the study. Average length of follow-up was 5.7years (SD-3.90). Sixty-four patients (57.5%) were nulliparous at the time of surgery. Sixty-one patients (54%) had never been married. Average number of pregnancies per patient prior to surgery was 0.93, and average number of births prior to surgery was 0.73. After surgery, a total of 17 women had a total of 35 pregnancies and 25 births. The average number of pregnancies and births after surgery was 1.27 and 0.96, respectively. Infertility was reported in one patient postoperatively. Patients who were younger at the time of surgery experienced a greater change in the number of pregnancies and births after surgery (p=0.0036 and 0.0060, respectively). Patients who received fewer antiepileptic drug medication trials by the time of surgery also had a greater change in the number of births after surgery (p=0.0362). Seizure onset localization and lateralization, presurgical seizure frequency, age at seizure onset, duration of epilepsy, and postoperative seizure outcome were not statistically significant factors. CONCLUSION The present retrospective observational study provides additional evidence for the importance of early surgical treatment in women with drug-resistant focal epilepsy. Patients who had received fewer medications prior to surgery were more likely to experience an increase in births following surgery. The significance of these findings requires further investigation but may support a role for earlier surgical intervention in the management of drug-resistant focal epilepsy.
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Affiliation(s)
- Rachel R Fabris
- Mayo Clinic, Division of Epilepsy, Department of Neurology, Rochester, MN, United States
| | | | - Jay Mandrekar
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN, United States
| | - W Richard Marsh
- Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States
| | - Frederic B Meyer
- Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States
| | - Gregory D Cascino
- Mayo Clinic, Division of Epilepsy, Department of Neurology, Rochester, MN, United States
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Abstract
Studies of syndromic hydrocephalus have led to the identification of >100 causative genes. Even though this work has illuminated numerous pathways associated with hydrocephalus, it has also highlighted the fact that the genetics underlying this phenotype are more complex than anticipated originally. Mendelian forms of hydrocephalus account for a small fraction of the genetic burden, with clear evidence of background-dependent effects of alleles on penetrance and expressivity of driver mutations in key developmental and homeostatic pathways. Here, we synthesize the currently implicated genes and inheritance paradigms underlying hydrocephalus, grouping causal loci into functional modules that affect discrete, albeit partially overlapping, cellular processes. These in turn have the potential to both inform pathomechanism and assist in the rational molecular classification of a clinically heterogeneous phenotype. Finally, we discuss conceptual methods that can lead to enhanced gene identification and dissection of disease basis, knowledge that will potentially form a foundation for the design of future therapeutics.
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Affiliation(s)
- Maria Kousi
- Center for Human Disease Modeling, Duke University School of Medicine, Durham, North Carolina 27701;
| | - Nicholas Katsanis
- Center for Human Disease Modeling, Duke University School of Medicine, Durham, North Carolina 27701;
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Kacirova I, Grundmann M, Brozmanova H. Concentrations of carbamazepine and carbamazepine-10,11-epoxide in maternal and umbilical cord blood at birth: Influence of co-administration of valproic acid or enzyme-inducing antiepileptic drugs. Epilepsy Res 2016; 122:84-90. [PMID: 26991491 DOI: 10.1016/j.eplepsyres.2016.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 02/03/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
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Folic acid supplementation: what is new? Fetal, obstetric, long-term benefits and risks. Future Sci OA 2016; 2:FSO116. [PMID: 28031963 PMCID: PMC5137972 DOI: 10.4155/fsoa-2015-0015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/24/2016] [Indexed: 01/08/2023] Open
Abstract
The association between folic acid supplementation, prior to conception and/or during pregnancy and pregnancy outcomes, has been the subject of numerous studies. The worldwide recommendation of folic acid is at least 0.4 mg daily for all women of reproductive age, and 4–5 mg in high-risk women. In addition, evidence shows that folic acid supplementation could modulate other adverse pregnancy outcomes, specifically, in pregnancies complicated by seizure disorders, preeclampsia, anemia, fetal growth restriction and autism. This review summarizes the available national and international guidelines, concerning the indications and dosage of folic acid supplementation during pregnancy. In addition, it describes the potential preventive benefits of folic acid supplementation on multiple maternal and fetal outcomes, as well as potential risks.
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Abstract
Medication management of bipolar depression in pregnancy and lactation is best done by assessing each patient's and family's needs in detail. Keeping pregnant patients as psychiatrically stable as possible is the most important principle for clinicians. Unfortunately, there is no risk-free situation for patients with psychiatric illness. This is often the most difficult and hard to accept reality for these patients, families, and clinicians. Clinicians serve these patients best by being as transparent as possible about the risk/benefit analysis of each patient's situation with the realization that ultimately the decisions are made by the patient and family.
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Affiliation(s)
- Marla F Wald
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Civitan Building, 2213 Elba Street, Durham, NC 27705, USA.
| | - Andrew J Muzyk
- Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | - Drue Clark
- Mission Health Outpatient Clinical Pharmacy Services, Asheville, NC, USA
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Vajda F, O’Brien T, Graham J, Lander C, Eadie M. Is carbamazepine a human teratogen? J Clin Neurosci 2016; 23:34-37. [DOI: 10.1016/j.jocn.2015.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 11/29/2022]
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Update on diagnosis and management of childhood epilepsies. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bhakta J, Bainbridge J, Borgelt L. Teratogenic medications and concurrent contraceptive use in women of childbearing ability with epilepsy. Epilepsy Behav 2015; 52:212-7. [PMID: 26460786 DOI: 10.1016/j.yebeh.2015.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/07/2015] [Accepted: 08/04/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many antiepileptic drugs (AEDs) have the potential to cause teratogenicity. We evaluated eight antiepileptic drugs (AEDs) classified as Federal Drug Administration (FDA) pregnancy category D, X, or N designations and having documented teratogenic effects. These include carbamazepine, ethosuximide, fosphenytoin, phenobarbital, phenytoin, primidone, topiramate, and valproate. Women with epilepsy (WWE) may need one or more of these AEDs for seizure control but may be unaware of the potential teratogenicity associated with their use. In utero exposure to AEDs increases the risks for both congenital malformations and other teratogenic defects. Given that approximately 50% of pregnancies are unintended, it is likely that women with epilepsy taking these medications could unknowingly put a growing fetus at risk. For women using contraception while taking these medications, many choose combined hormonal contraceptives (CHCs). Drug-drug interactions exist between AEDs and CHCs that may decrease contraceptive efficacy. The aim of this study was to evaluate prescribing patterns for potentially teratogenic AEDs and contraceptive use in WWE of childbearing ability, including those with potential drug-drug interactions. This study also determined the number of WWE of childbearing ability prescribed potentially teratogenic AEDs and documentation of a pregnancy or contraception plan. METHODS This was a retrospective, observational study of WWE age 15-44 years, of childbearing ability, prescribed an AED from July 1, 2011 to June 30, 2012, and who had an appointment at the University of Colorado Hospital Outpatient Neurology Clinic (Anschutz Medical Campus). RESULTS One hundred fifteen women with an average age of 30.7 years and various types of seizures were evaluated. The majority of patients were prescribed topiramate (34/115, 30%) or carbamazepine (27/115, 23%). Of the women, 30/115 (26%) had a documented contraception method when taking a potentially teratogenic AED. Of these women prescribed contraception, most (18/30, 60%) used an oral combined hormonal contraceptive or progestin-only pill, a majority of which had a potential for a drug-drug interaction with their AEDs (16/18, 89%). Less than 7% of women received counseling on a contraception plan, and 18% of subjects received counseling on a pregnancy plan. CONCLUSIONS Most WWE of childbearing ability taking potentially teratogenic AEDs were not using contraception. Those using contraception frequently had a method that has a significant drug-drug interaction which reduces the effectiveness of contraception. Women with epilepsy of childbearing ability prescribed an AED should be using effective contraception or participating in active discussions about pregnancy planning to avoid unplanned pregnancies and possible teratogenic effects of these AEDs. Documentation about pregnancy planning or contraceptive use in WWE of childbearing ability is minimal and should be discussed at least annually. It is critical for providers to discuss with WWE of childbearing ability the benefits and risks of various AED treatments; the need to select appropriate, effective contraception when pregnancy is not desired; and the importance of counseling regarding contraceptive or pregnancy planning.
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Affiliation(s)
- Janki Bhakta
- University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora, CO, USA
| | - Jacquelyn Bainbridge
- University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora, CO, USA
| | - Laura Borgelt
- University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora, CO, USA.
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