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Holuka C, Grova N, Charalambous EG, Le Cléac H J, Turner JD, Mposhi A. Transgenerational impacts of early life adversity: from health determinants, implications to epigenetic consequences. Neurosci Biobehav Rev 2024; 164:105785. [PMID: 38945418 DOI: 10.1016/j.neubiorev.2024.105785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/09/2024] [Accepted: 06/23/2024] [Indexed: 07/02/2024]
Abstract
Exposure to different environmental factors, social and socioeconomic factors promotes development of the early-life adversity (ELA) phenotype. The persistence of this phenotype across generations is an interesting phenomenon that remains unexplored. Of late many studies have focused on disease-associated outcomes of ELA following exposure during childhood but the persistence of epigenetic imprints transmitted by ELA exposed parents to their offspring remains poorly described. It is possible that both parents are able to transmit ELA-associated genetic imprints to their offspring via transgenerational inheritance mechanisms. Here, we highlight the role of the mother and father in the biological process of conception, from epigenetic reprogramming cycles to later environmental exposures. We explain some of the known determinants of ELA (pollution, socioeconomic challenges, infections, etc.) and their disease-associated outcomes. Finally, we highlight the role of epigenetics, mitochondria and ncRNAs as mechanisms mediating transgenerational inheritance. Whether these transgenerational inheritance mechanisms occur in the human context remains unclear but there is a large body of suggestive evidence in non-human models that points out to its existence.
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Affiliation(s)
- Cyrielle Holuka
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg; Faculty of Science, University of Luxembourg, Belval L-4365, Luxembourg
| | - Nathalie Grova
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg; UMR Inserm 1256 nGERE, Nutrition-Génétique et exposition aux risques environnementaux, Institute of Medical Research (Pôle BMS) - University of Lorraine, B.P. 184, Nancy 54511, France
| | - Eleftheria G Charalambous
- Department of Psychiatry and Psychotherapy, University Medecine Greifswald, Ellernholzstr. 1-2, Greifswald 17489, Germany; Department of Psychology, University of Cyprus, Nicosia 2109, Cyprus
| | - Jeanne Le Cléac H
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg; Faculty of Science, University of Luxembourg, Belval L-4365, Luxembourg
| | - Jonathan D Turner
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg.
| | - Archibold Mposhi
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
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Leinonen MK, Igland J, Dreier JW, Alvestad S, Cohen JM, Gilhus NE, Gissler M, Sun Y, Tomson T, Zoega H, Vegrim HM, Christensen J, Bjørk MH. Socioeconomic differences in use of antiseizure medication in pregnancies with maternal epilepsy: A population-based study from Nordic universal health care systems. Epilepsia 2024; 65:2397-2411. [PMID: 38804650 DOI: 10.1111/epi.18022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy. METHODS We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference. RESULTS Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36). SIGNIFICANCE Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.
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Affiliation(s)
- Maarit K Leinonen
- Finnish Institute for Health and Welfare, Knowledge Brokers, Helsinki, Finland
- Department of Neurology, Aarhus University Hospital, Affiliated Member of the European Reference Network EpiCARE, Aarhus, Denmark
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Julie Werenberg Dreier
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Silje Alvestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Oslo, Norway
| | - Jacqueline M Cohen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Knowledge Brokers, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Yuelian Sun
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Håkon M Vegrim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Affiliated Member of the European Reference Network EpiCARE, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marte-Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
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Forbes H, Madley-Dowd P, Ahlqvist V, Campbell J, Davies NM, Liebling R, Lyall K, Newschaffer C, Rast J, Tomson T, Zhong C, Magnusson C, Rai D, Lee BK. First-trimester use of antiseizure medications and the risk of miscarriage: a population-based cohort study. J Neurol Neurosurg Psychiatry 2024; 95:693-703. [PMID: 38777577 PMCID: PMC11287565 DOI: 10.1136/jnnp-2023-333149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Antiseizure medications (ASMs) during the first trimester of pregnancy have been associated with an increased risk of miscarriage. METHODS We carried out a population-based cohort study using routinely collected healthcare data from the UK, 1995-2018. Pregnancies were identified in the Clinical Practice Research Datalink and we estimated the HR of miscarriage associated with prescriptions of ASMs during the first trimester of pregnancy, using Cox regression, adjusting for potential confounders, including ASM indications. RESULTS ASMs were prescribed during the first trimester in 7832 (0.8%) of 1 023 787 included pregnancies. 14.5% of pregnancies with first-trimester exposure to ASMs ended in miscarriage, while 12.2% without ASM exposure in the first trimester ended in miscarriage; after adjustment, there was a 1.06-fold relative hazard of miscarriage (95% CI 1.00 to 1.13) in women with first-trimester ASM use. After restricting to women with specific ASM indications, this association was not evident in women with epilepsy (adjusted HR 0.98, 95% CI 0.89 to 1.08), but was observed in women with bipolar or other psychiatric conditions (1.08, 95% CI 1.00 to 1.16) although CIs overlapped. Compared with discontinuation of ASMs prior to pregnancy, there was no evidence of increased risk of miscarriage for first-trimester ASM use in women with bipolar or other psychiatric conditions (1.02, 95% CI 0.87 to 1.20). CONCLUSION We found no clear evidence to suggest that first-trimester ASM use increased the risk of miscarriage. Taken together, our analyses suggest that apparent associations between first-trimester ASM use and miscarriage may be the result of confounding by the presence of a bipolar disorder or associated unmeasured variables.
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Affiliation(s)
- Harriet Forbes
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Madley-Dowd
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Viktor Ahlqvist
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Jennifer Campbell
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Division of Psychiatry, University College London, London, UK
- K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rachel Liebling
- Department of Obstetrics, University Hospitals Bristol and Weston, National Health Service England, Redditch, UK
| | - Kristen Lyall
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Craig Newschaffer
- College of Health and Human Development, The Pennsylvania State University, Pennsylvania, Texas, USA
| | - Jessica Rast
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- A.J. Drexel Autism Institute, Philadelphia, Pennsylvania, USA
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Caichen Zhong
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
| | - Brian K Lee
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- A.J. Drexel Autism Institute, Philadelphia, Pennsylvania, USA
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Li L, Wang K, Wang M, Tao J, Li X, Liu Z, Li N, Qiu X, Wei H, Lin Y, He Y, Deng Y, Kang H, Li Y, Yu P, Wang Y, Zhu J, Liu H. The maternal drug exposure birth cohort (DEBC) in China. Nat Commun 2024; 15:5312. [PMID: 38906856 PMCID: PMC11192739 DOI: 10.1038/s41467-024-49623-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/12/2024] [Indexed: 06/23/2024] Open
Abstract
Drug exposure during pregnancy lacks global fetal safety data. The maternal drug exposure birth cohort (DEBC) study, a prospective longitudinal investigation, aims to explore the correlation of maternal drug exposure during pregnancy with pregnancy outcomes, and establish a human biospecimen biobank. Here we describe the process of establishing DEBC and show that the drug exposure rate in the first trimester of pregnant women in DEBC (n = 112,986) is 30.70%. Among the drugs used, dydrogesterone and progesterone have the highest exposure rates, which are 11.97% and 10.82%, respectively. The overall incidence of adverse pregnancy outcomes is 13.49%. Dydrogesterone exposure during the first trimester is correlated with higher incidences of stillbirth, preterm birth, low birth weight, and birth defects, along with a lower incidence of miscarriage/abortion. Due to the limitations of this cohort study, causative conclusions cannot be drawn. Further follow-up and in-depth data analysis are planned for future studies.
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Affiliation(s)
- Lu Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ke Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Meixian Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jing Tao
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen Liu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Nana Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoxia Qiu
- The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Hongwei Wei
- The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yuan Lin
- Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian, China
| | - Yuan He
- National Research Institute for Family Planning, National Human Genetic Resource Center, Beijing, China
| | - Ying Deng
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Kang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuting Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Yu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Yanping Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Jun Zhu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Laspro M, Brydges HT, Verzella AN, Schechter J, Alcon A, Roman AS, Flores RL. Association of Commonly Prescribed Antepartum Medications and Incidence of Orofacial Clefting. Cleft Palate Craniofac J 2024:10556656241237679. [PMID: 38449319 DOI: 10.1177/10556656241237679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Pharmacologic agents are often used in the antepartum period, however, studies on their effect on fetal development are limited. Thus, this study aims to examine the effect of commonly prescribed antepartum medications on the development of orofacial clefting. METHODS Utilizing EPIC Cosmos deidentified data from approximately 180 US institutions was queried. Patients born between January 1, 2013, to January 1, 2023, were included. Eight OC cohorts were identified. Gestational medication use was identified by medications prescribed, provider-administered, or reported use by mothers. Medications used in at least 1 in 10,000 pregnancies were included in this analysis. RESULTS A total of 12 098 newborns with available maternal pharmacologic data were born with any type of orofacial clefting. Prevalence for all oral clefts, any cleft palate, and any cleft lip were 20.56, 18.10, and 10.60 per 10 000 individuals, respectively. Notable significant exposures include most anticonvulsants, such as lamotrigine (OR1.33, CI 1.10-1.62), and topiramate (OR1.35, CI 1.13-1.62), as well as nearly all SSRIs/SNRIs, including fluoxetine (OR1.34, CI 1.19-1.51), sertraline (OR1.25, CI 1.16-1.34), and citalopram (OR1.28, CI 1.11-1.47). Corticosteroids were also correlated including dexamethasone (OR1.19, CI 1.12-1.27), and betamethasone (OR1.64, CI 1.55-1.73), as were antibiotics, including amoxicillin (OR1.22, CI 1.14-1.30), doxycycline (OR1.29, CI 1.10-1.52), and nitrofuran derivatives (OR1.10, CI 1.03-1.17). CONCLUSION New associations between commonly prescribed antepartum medications and orofacial clefting were found. These findings should be confirmed as causality is not assessed in this report. Practitioners should be aware of the potential increased risk associated with these medications.
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Affiliation(s)
- Matteo Laspro
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Alexandra N Verzella
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jill Schechter
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Andre Alcon
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Ashley S Roman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Ershadi F, Mousavi Mirzaei SM, Tabrizi N, Roshanravan B, Sahebnasagh A, Avan R. Evaluation of family planning methods in married women with epilepsy. Epilepsy Behav 2022; 129:108618. [PMID: 35257991 DOI: 10.1016/j.yebeh.2022.108618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/13/2022] [Accepted: 02/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Epilepsy is one of the most common neurologic unit diseases that have different prevalence in different parts of the world. Antiepileptic drugs (AEDs) are associated with major fertility risks for women of childbearing age. Due to the fact that studies on family planning methods in married women with epilepsy (WWE) have not been conducted in Iran, the aim of this study was to evaluate the family planning methods in married WWE in Birjand, Iran. METHODS An analytical-descriptive study was performed on 126 married WWE hospitalized in the neurology ward or referred to Vali-e-Asr specialized and sub-specialized clinic in Birjand. Demographic information of patients as well as data on the type of used AED, and various methods of family planning were collected in a questionnaire. Data analysis was performed using Chi-square and Fisher tests. All of the above analyses were considered at a significance level of less than 5% by SPSS v.19 software. RESULTS The mean age of the patients was 33.41 ± 9.15 years. The mean age of experiencing the first seizure and the onset of menstruation were 24.82 and 13.79 years, respectively. Fifty (35.5%), 38 (27%), 15 (10.6%), 14 (9.9%), and 14 (9.9%) patients used sodium valproate, carbamazepine, phenytoin, levetiracetam, and lamotrigine, respectively. The results showed that 72 sexually active patients (70.6%) used family planning methods, of which 43 patients (59.7%) used withdrawal method, 20 patients (27.8%) used condoms, and 6 patients (8.3%) used oral contraceptive pills (OCP). Eight patients (9.6%) had a history of unintended pregnancy and 3 patients (3.6%) had a history of abortion. CONCLUSION It is recommended to apply effective family planning methods in married WWE to prevent unintended pregnancies and the subsequent adverse effects in the fetus, considering the fact that a significant percentage of WWE did not use effective family planning methods and 8 cases of unintended pregnancies were reported. Because of high consumption of valproate in women of childbearing age in our study and concerning issue about its fetal malformation, it is recommended to reduce the administration of valproate in this population. Moreover, regarding the low consumption of folic acid, especially for women of childbearing age and pregnant WWE who are taking AED, the necessary recommendations should be made by our physicians.
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Affiliation(s)
- Faranak Ershadi
- Medical Student, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Nasim Tabrizi
- Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Razieh Avan
- Department of Clinical Pharmacy, School of Pharmacy, Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Reardon T, Fiani B, Kosarchuk J, Parisi A, Shlobin NA. Management of Lambdoid Craniosynostosis: A Comprehensive and Systematic Review. Pediatr Neurosurg 2022; 57:1-16. [PMID: 34864743 DOI: 10.1159/000519175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Craniosynostosis is a condition characterized by the premature fusion of 2 or more skull bones. Craniosynostosis of the lambdoid suture is one of the rarest forms, accounting for 1-4% of all craniosynostoses. Documented cases are separated into simple (single suture), complex (bilateral), and associated with adjacent synostoses ("Mercedes Benz" Pattern) or syndromes (i.e., Crouzon, Sathre-Chotzen, Antley-Bixler). This condition can manifest phenotypic deformities and neurological sequelae that can lead to impaired cognitive function if improperly treated or left undiagnosed. Preferred surgical techniques have varied over time but all maintain the common goals of establishing proper head shape and preventing of complications that could contribute to aforementioned sequelae. SUMMARY This comprehensive review highlights demographic distributions, embryological development, pathogenesis, clinical presentation, neurological sequelae, radiologic findings, surgical techniques, surgical outcomes, and postoperative considerations of patients with lambdoid craniosynostosis presentation. In addition, a systematic review was conducted to explore the operative management of lambdoid craniosynostosis using PubMed, Embase, and Scopus databases, with 38 articles included after screening. Key Messages: Due to a low volume of published cases, diagnosis and treatment can vary. Large overlap in presentation can occur in patients that display lambdoid craniosynostosis and posterior plagiocephaly, furthering the need for comprehensive analysis. Possessing the knowledge and tools to properly assess patients with lambdoid craniosynostosis will allow for more precise care and improved outcomes.
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Affiliation(s)
- Taylor Reardon
- Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
| | - Brian Fiani
- Desert Regional Medical Center, Palm Springs, California, USA
| | | | | | - Nathan A Shlobin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Gulati S, N M S. Craniosynostosis: A pediatric neurologist’s perspective. J Pediatr Neurosci 2022; 17:S54-S60. [DOI: 10.4103/jpn.jpn_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/12/2022] [Indexed: 11/04/2022] Open
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Shrestha O, Pant P, Devkota N, Gurung D, Shrestha DB. Carbamazepine induced toxic epidermal necrolysis and Stevens-Johnson syndrome overlapping during pregnancy in a South-East Asian patient: A case report. Ann Med Surg (Lond) 2021; 68:102616. [PMID: 34386220 PMCID: PMC8346553 DOI: 10.1016/j.amsu.2021.102616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare and severe forms of drug-induced skin reaction. Most frequently involved drugs are noted to be non-steroidal anti-inflammatory agents, antibiotics, and anticonvulsants. These have high morbidity and mortality and counts among dermatological emergencies. Case presentation We report an eventful case of a 22-year-old lady who suffered and recovered from carbamazepine-induced SJS/TEN overlapping during her pregnancy. Our patient had a history of epilepsy for which she was under sodium valproate. Switching to carbamazepine due to its low teratogenicity led our patient to this condition. History of prodromal symptoms and exposure to carbamazepine helped in the diagnosis. Carbamazepine abstinence and a multidisciplinary approach in symptomatic management worked very well for the patient. Clinical discussion Carbamazepine-induced TES/SJS manifests multisystem effects and requires a multidisciplinary approach for management. The condition itself is life-threatening and in its addition, their sequelae further threaten the life of the patients. Early intervention is the key. Genetically susceptible are thought to be the ones carrying human leukocyte antigen B*15:02 (HLA-B*15:02) allele and it is most prevalent in South-East Asian populations. Screening of this allele before using carbamazepine prevents the incidence of carbamazepine-induced SJS/TEN. Conclusion Prodromal symptoms of carbamazepine-induced SJS/TEN constitute flu-like symptoms that should not be missed. Early intervention and multidisciplinary approach prevent secondary infections and complications. Screening for HLA-B*15:02 variant allele and close monitoring of these adverse reactions along with proper counseling to patients goes a long way in preventing the development of this life-threatening condition. Carbamazepine-induced cutaneous reaction may present as Stevens-Johnson Syndrome (SJS) or toxic epidermal necrolysis (TEN). Carriers of the human leukocyte antigen B*1502 gene are susceptible to developing carbamazepine-induced SJS/TEN. Human leukocyte antigen B*1502 gene is most prevalent in South-East Asia. SJS/TEN affect multisystem and need a multidisciplinary approach in management.
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Affiliation(s)
- Oshan Shrestha
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
- Corresponding author.
| | - Prashant Pant
- Department of Emergency Medicine and Critical Care Unit, Karnali Academy of Health Sciences, Jumla, Nepal
| | - Nebula Devkota
- Department of Emergency Medicine and Critical Care Unit, Karnali Academy of Health Sciences, Jumla, Nepal
| | - Dhiraj Gurung
- Department of Internal Medicine, Karnali Academy of Health Sciences, Jumla, Nepal
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10
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Therapeutic Drug Monitoring of Antiseizure Medications Using Volumetric Absorptive Microsampling: Where Are We? Pharmaceuticals (Basel) 2021; 14:ph14070627. [PMID: 34209566 PMCID: PMC8308594 DOI: 10.3390/ph14070627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 12/25/2022] Open
Abstract
Therapeutic drug monitoring (TDM) of antiseizure medications (ASMs) represents a valuable tool to establish an appropriate patient therapy, to collect important information about drugs’ interactions and to evaluate patient’s metabolic capabilities. In recent years, a new volumetric absorptive microsampling technique using VAMS® technology and Mitra® devices, consisting of a sampling technique for the collection of fixed-volume capillary blood, was developed. These new devices provide a new home-sampling technique for whole blood that has been spread out to simplify sample collection from finger-pricks. This review is aimed to compare published articles concerning the application of VAMS® in epilepsy and to identify the strengths and improvement points for the TDM of antiseizure medications. VAMS® allowed a minimally invasive blood sampling even in the absence of trained personnel. Good stability data have indicated that storage and delivery can be facilitated only for specific ASMs. Trueness and precision parameters have been evaluated, and the hematocrit (HCT) effect was minimized.
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11
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Ursini T, Di Giacomo R, Caldrer S, Angheben A, Zammarchi L, Filipponi S, Pizio NR, Bisoffi Z, Buonfrate D. Neurocysticercosis-related seizures in the post-partum period: two cases and a review of the literature. THE LANCET. INFECTIOUS DISEASES 2020; 20:e204-e214. [PMID: 32569624 DOI: 10.1016/s1473-3099(20)30240-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Abstract
Neurocysticercosis, the infection of the CNS with larval cysts of Taenia solium, is a leading cause of seizures in low-income countries. The clinical presentation of neurocysticercosis is variable and depends on the number, size, and location of cysticerci, and on the immune response of the host. In most patients, the affected site is the brain parenchyma, where cysts can precipitate seizures. Neurocysticercosis has seldom been described in pregnant women. In this Grand Round, we report two cases of pregnant women who immigrated to Italy from Bolivia and Ecuador, and who developed seizures in the early post-partum period, due to calcified parenchymal neurocysticercosis lesions. We discuss the complex interactions between neurocysticercosis and the immune system in pregnancy and the post-partum period. Building on this scenario, we propose practices for the management of neurocysticercosis in pregnancy and the post-partum period, highlighting important gaps in the literature that should be addressed.
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Affiliation(s)
- Tamara Ursini
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.
| | - Roberta Di Giacomo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Caldrer
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Andrea Angheben
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Stefania Filipponi
- Stroke Unit, Department of Neurological Disorders, Santa Chiara Hospital, Trento, Italy
| | | | - Zeno Bisoffi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Dora Buonfrate
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
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12
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Canisius TP, Soons JH, Verschuure P, Wammes-van der Heijden EA, Rouhl RP, Majoie HM. Therapeutic drug monitoring of anti-epileptic drugs – a clinical verification of volumetric absorptive micro sampling. ACTA ACUST UNITED AC 2020; 58:828-835. [DOI: 10.1515/cclm-2019-0784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022]
Abstract
AbstractBackgroundTherapeutic drug monitoring (TDM) of antiepileptic drugs (AEDs) can serve as a valuable tool in optimising and individualising epilepsy treatment, especially in vulnerable groups such as pregnant women, the elderly and children. Unfortunately, TDM is often performed suboptimally due to limitations in blood collection. Therefore, we investigated volumetric absorptive micro sampling (VAMS) – a new home-sampling technique. We aimed to evaluate VAMS to determine and quantify the different AEDs and concentrations of 16 different AEDs in whole blood collected by VAMS.MethodsPatient blood samples (n = 138) were collected via venepunctures at the Academic Centre for Epileptology Kempenhaeghe. AED concentrations were determined, and these concentrations were used to compare the VAMS method (whole blood) with the conventional method (serum). In addition, the recovery was examined as well as the impact of haematocrit. Finally, AED-spiked blood was used to test the stability of the AEDs inside the micro-sampler devices over a period of time and whether temperature had an effect on the stability.ResultsVAMS allows for an accurate detection of 16 different AEDs within 2 days after sampling. Deviation in recovery was less than 10% and high correlations were found between VAMS and conventional sampling. Moreover, haematocrit does not have an effect with values between 0.3 and 0.5 (L/L). Finally, although storage temperature of VAMS does affect some AEDs, most are unaffected.ConclusionsVAMS enables an accurate detection of a wide variety of AEDs within 2 days after sampling.
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Affiliation(s)
- Thierry P.I.J.M. Canisius
- Laboratory Clinical Chemistry and Pharmacology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, VE Heeze, the Netherlands
| | - J.W.P. Hans Soons
- Laboratory Clinical Chemistry and Pharmacology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, VE Heeze, the Netherlands
| | - Pauline Verschuure
- Laboratory Clinical Chemistry and Pharmacology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, VE Heeze, the Netherlands
| | - Emmeke A. Wammes-van der Heijden
- Laboratory Clinical Chemistry and Pharmacology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, VE Heeze, the Netherlands
| | - Rob P.W. Rouhl
- Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, Heeze, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - H.J. Marian Majoie
- Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, Heeze, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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13
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Abstract
Focal-onset seizures are among the most common forms of seizures in children and adolescents and can be caused by a wide diversity of acquired or genetic etiologies. Despite the increasing array of antiseizure drugs available, treatment of focal-onset seizures in this population remains problematic, with as many as one-third of children having seizures refractory to medications. This review discusses contemporary concepts in focal seizure classification and pathophysiology and describes the antiseizure medications most commonly chosen for this age group. As antiseizure drug efficacy is comparable in children and adults, here we focus on pharmacokinetic aspects, drug-drug interactions, and side effect profiles. Finally, we provide some suggestions for choosing the optimal medication for the appropriate patient.
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Affiliation(s)
- Clare E Stevens
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Rubenstein Bldg 2157, 200N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Rubenstein Bldg 2157, 200N. Wolfe Street, Baltimore, MD, 21287, USA.
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14
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Abstract
INTRODUCTION Epilepsy is a serious chronic neurological disorder manifested by an enduring symptomatic predisposition to seizures. Newly diagnosed individuals face increased morbidity, mortality, and socioeconomic costs. Anti-epileptic drug therapy is the treatment usually prescribed, which has efficacy in seizure control and mitigating long-term mortality. AREAS COVERED Safety of anti-epileptic drug therapy in adults with a focus in newly diagnosed patients. Areas covered include the most commonly experienced adverse drug effects, as well as those with the highest impacts on drug tolerability, quality of life, morbidity and mortality. Evidence was also reviewed to identify clinical strategies to improve the safety of anti-epileptic drug therapy. EXPERT OPINION Anti-epileptic drugs (AEDs) are mostly effective and well tolerated. However, a lack of standardised reporting of adverse drug effects in trials and in clinical practice provides an obstacle for evaluation of which adverse drug effects need to be prioritised in management. Improvement in the reporting of cognitive and other effects, as well as improved precision medicine and pharmacogenomics to target the incidence of high-mortality idiosyncratic reactions, will help to reduce the harm of AEDs in people newly diagnosed with epilepsy.
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Affiliation(s)
- Sameer Sharma
- a Department of Neuroscience , Central Clinical School, Monash University , Melbourne , Australia
| | - Patrick Kwan
- a Department of Neuroscience , Central Clinical School, Monash University , Melbourne , Australia.,b Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Melbourne , Australia.,c School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia
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15
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Panchaud A, Cohen JM, Patorno E, Huybrechts KF, Desai RJ, Gray KJ, Mogun H, Hernandez-Diaz S, Bateman BT. Anticonvulsants and the risk of perinatal bleeding complications: A pregnancy cohort study. Neurology 2018; 91:e533-e542. [PMID: 29980637 DOI: 10.1212/wnl.0000000000005944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the risk of postpartum hemorrhage (PPH) and neonatal bleeding complications associated with late-pregnancy exposure to anticonvulsant drugs (ACDs) that induce cytochrome P450 enzymes (ACDi) and alter the metabolism of vitamin K compared to other ACDs. METHODS We used a population-based cohort study stemming from a nationwide sample of publicly insured pregnant women with a liveborn infant from the 2000 to 2010 Medicaid Analytic eXtract. ACDi (carbamazepine, phenobarbital, phenytoin, oxcarbazepine, topiramate) were compared to other ACDs dispensed during the last month of pregnancy. Relative risks (RRs) and 95% confidence intervals (CIs) of PPH and neonatal bleeding complications were estimated using generalized linear models with fine stratification on the propensity score to control for indication and other potential confounders. RESULTS Among 11,572 women with an ACD prescription overlapping delivery, 2.6% (135/5,109) in the ACDi group and 3.6% (231/6,463) in the other ACDs group had a diagnosis of PPH: unadjusted RR 0.74 (95% CI 0.60-0.91), adjusted RR 0.77 (95% CI 0.58-1.00). The prevalence of neonatal bleeding complications was 3.1% (157/5,109) in the ACDi group and 3.5% (229/6,463) in the other ACDs group: unadjusted RR 0.87 (95% CI 0.71-1.06), adjusted RR 0.83 (95% CI 0.64-1.08). CONCLUSIONS Evidence from this large observational study suggests that use of ACDi near delivery does not increase the risk of bleeding complications compared to other ACDs in clinical settings where neonatal intramuscular or oral vitamin K administration is considered standard of care. These findings provide reassurance for clinicians and pregnant women successfully treated with ACDi.
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Affiliation(s)
- Alice Panchaud
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
| | - Jacqueline M Cohen
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Elisabetta Patorno
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Krista F Huybrechts
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Rishi J Desai
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Kathryn J Gray
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Helen Mogun
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Sonia Hernandez-Diaz
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Brian T Bateman
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
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16
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Davis Jones G, Hitchcock A, Vajda F, Craig J, O'Brien TJ, Sen A. Development of EpiRisk: An online clinical tool for estimating the risk of major congenital malformations in pregnant women treated for epilepsy. Epilepsia Open 2018; 3:281-285. [PMID: 29881808 PMCID: PMC5983143 DOI: 10.1002/epi4.12109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 11/10/2022] Open
Abstract
Antiepileptic drugs (AEDs) are known to associate with an increased risk of major congenital malformations (MCMs) in children born to women who become pregnant while taking them. As the indications for AEDs continue to diversify, novel AEDs emerge, and polytherapy becomes more prevalent, the volume and complexity of the information relating to teratogenic risk can become unmanageable for the clinician. This in turn makes accurate education of pregnant women treated with AEDs regarding the risk of MCMs challenging. To enable clinicians to provide better information regarding the potential teratogenic risk of AEDs, we outline here the method we have employed to underpin a new system of real-time risk analysis, "EpiRisk." When launched, EpiRisk will offer a user-friendly, online clinical tool, compatible with all modern Internet browsers, smart phones, and personal computers. Using the most current published data, as well as "real world" data from the UK and the Australian Pregnancy Registers, EpiRisk will enable clinicians to quickly and accurately assess the teratogenic risk of AEDs in mono- and polytherapy. EpiRisk may thus provide a future-proof central hub for empowering patients, clinicians, and registries by delivering evidence-based information on the teratogenic risk of the AEDs in pregnant women with epilepsy through an easily accessible platform.
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Affiliation(s)
- Gabriel Davis Jones
- Oxford Epilepsy Research Group NIHR Biomedical Research Centre Nuffield Department of Clinical Neurosciences John Radcliffe Hospital and The University of Oxford Oxford United Kingdom.,The Departments of Medicine and Neurology The Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia
| | - Alison Hitchcock
- The Departments of Medicine and Neurology The Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia.,Australian Pregnancy Register for Women on Antiepileptic Medication Melbourne Victoria Australia
| | - Frank Vajda
- The Departments of Medicine and Neurology The Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia.,Australian Pregnancy Register for Women on Antiepileptic Medication Melbourne Victoria Australia
| | - John Craig
- UK Epilepsy & Pregnancy Register Belfast United Kingdom
| | - Terence J O'Brien
- The Departments of Medicine and Neurology The Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia.,Australian Pregnancy Register for Women on Antiepileptic Medication Melbourne Victoria Australia.,The Department of Neurosciences and The Department of Neurology Central Clinical School The Alfred Hospital Monash University Melbourne Victoria Australia
| | - Arjune Sen
- Oxford Epilepsy Research Group NIHR Biomedical Research Centre Nuffield Department of Clinical Neurosciences John Radcliffe Hospital and The University of Oxford Oxford United Kingdom
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Kajdic N, Spazzapan P, Velnar T. Craniosynostosis - Recognition, clinical characteristics, and treatment. Bosn J Basic Med Sci 2018. [PMID: 28623672 DOI: 10.17305/bjbms.2017.2083] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Craniosynostosis is a developmental craniofacial anomaly, resulting in impairment of brain development and abnormally shaped skull. The main cause of craniosynostosis is premature closure of one or more cranial sutures. It usually occurs as an isolated condition, but may also be associated with other malformations as part of complex syndromes. When left untreated, craniosynostosis can cause serious complications, such as developmental delay, facial abnormality, sensory, respiratory and neurological dysfunction, anomalies affecting the eye, and psychological disturbances. Thus, early diagnosis, expert surgical techniques, postoperative care, and adequate follow-up are of vital importance in treating craniosynostosis.
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Affiliation(s)
- Nina Kajdic
- Chair of Surgery, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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18
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Shawahna R. Which information on women's issues in epilepsy does a community pharmacist need to know? A Delphi consensus study. Epilepsy Behav 2017; 77:79-89. [PMID: 29127865 DOI: 10.1016/j.yebeh.2017.09.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to develop and achieve consensus on a core list of important knowledge items that community pharmacists should know on women's issues in epilepsy. METHODS This was a consensual study using a modified Delphi technique. Knowledge items were collected from the literature and from nine key contacts who were interviewed on their views on what information community pharmacists should have on women's issues in epilepsy. More knowledge items were suggested by five researchers with interest in women's issues who were contacted to rate and comment on the knowledge items collected. Two iterative Delphi rounds were conducted among a panel of pharmacists (n=30) to achieve consensus on the knowledge items to be included in the core list. Ten panelists ranked the knowledge items by their importance using the Analytical Hierarchy Process (AHP). RESULTS Consensus was achieved to include 68 knowledge under 13 categories in the final core list. Items ranked by their importance were related to the following: teratogenicity (10.3%), effect of pregnancy on epilepsy (7.4%), preconception counseling (10.3%), bone health (5.9%), catamenial epilepsy (7.4%), menopause and hormonal replacement therapy (2.9%), contraception (14.7%), menstrual disorders and infertility (8.8%), eclampsia (2.9%), breastfeeding (4.4%), folic acid and vitamin K (5.9%), counseling on general issues (14.7%), and sexuality (4.4%). CONCLUSION Using consensual knowledge lists might promote congruence in educating and/or training community pharmacists on women's issues in epilepsy. Future studies are needed to investigate if such lists can improve health services provided to women with epilepsy (WWE).
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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19
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Halani S, Tshering L, Bui E, Clark SJ, Grundy SJ, Pem T, Lhamo S, Dema U, Nirola DK, Dorji C, Mateen FJ. Contraception, pregnancy, and peripartum experiences among women with epilepsy in Bhutan. Epilepsy Res 2017; 138:116-123. [PMID: 29128586 DOI: 10.1016/j.eplepsyres.2017.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/11/2017] [Accepted: 10/15/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Reports on the reproductive health of women with epilepsy (WWE) in low- and middle-income countries (LMICs) are limited. Bhutan is a lower income country with a high estimated prevalence of epilepsy and no out-of-pocket payment requirements for health visits or medications. METHODS We developed a 10-category survey to interview WWE ages 20-59 years in the Kingdom of Bhutan to understand their contraceptive use and peripartum experiences. WWE were recruited from 2016-2017 from an existing epilepsy cohort and their reproductive health data were merged with epilepsy and socioeconomic data obtained from initial clinical evaluations performed between 2014 and 2016. RESULTS Of the 134 WWE eligible for the study, 94 were reachable and there was 1 refusal to participate (response rate 99% among reachable WWE; 69% of all WWE in the cohort). Of the 93 WWE (median age 27 years, range 20-52), 50 (54%) reported prior pregnancies. Of the entire cohort, 55 women responded on contraception: 26 (47%) WWE had never used contraception in their lifetime. Of the 29 WWE who had ever used contraception, the most commonly reported form was male condoms (14/29, 48%), followed by depot medroxyprogesterone acetate injections (13/29, 45%), and intrauterine devices (5/29, 17%). Sixty-three percent of WWE recalled receiving information on family planning (31 of 49). Of the 50 WWE with prior pregnancies, 37 of 46 (80%) used folic acid; 6 WWE reported commencing it in the first trimester while 29 WWE began supplementation in the second trimester. Primary school education or higher was associated with folic acid supplementation during pregnancy (26/29 vs. 11/17, p=0.040). Epilepsy affected at least one of the pregnancies in 38 of the cases (76%) with an average of 2.3 pregnancies per woman). There was a total of 86 pregnancies and an average inter-pregnancy interval of 3.5 years. Ninety-five percent of women attended prenatal care (36/38), 22% had at least one miscarriage (8/37), 14% had at least one pre-term delivery (5/36), and 21% had Caesarean sections (8/38). Seventeen of 38 (45%) of WWE had seizures during pregnancy. A majority of WWE (97%, 37 of 38) with a prior pregnancy reported breastfeeding their infant. CONCLUSIONS Nearly half of Bhutanese WWE did not use contraception; among those who used it, male condoms were most common but 11% were at risk of potential drug-drug interactions between oral contraception and enzyme-inducing antiepileptic drugs. Bhutanese WWE had a high rate of prenatal visits. Folic acid was prescribed in most pregnant WWE but the majority began supplementation in the second trimester. The number of pregnancies in WWE in Bhutan (2.3 per woman) was comparable to the number of children per women in Bhutan (2.3). Breastfeeding was practiced almost universally. Points of intervention may include pre-conception initiation of folic acid, optimization of dosing of AEDs with contraceptives, guidelines for peripartum seizure treatment, and establishment of a prospective registry for WWE and their offspring.
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Affiliation(s)
- Sheliza Halani
- Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A1, Canada
| | - Lhab Tshering
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Gongphel Lam, Thimphu, Bhutan
| | - Esther Bui
- Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A1, Canada; Department of Neurology, University Health Network, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Sarah J Clark
- Neurological Clinical Research Institute, Massachusetts General Hospital,165 Cambridge St., Suite 600, Boston 02114, USA
| | - Sara J Grundy
- Neurological Clinical Research Institute, Massachusetts General Hospital,165 Cambridge St., Suite 600, Boston 02114, USA
| | - Tandin Pem
- Department of Neurology, University Health Network, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Sonam Lhamo
- Department of Neurology, University Health Network, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Ugyen Dema
- Department of Neurology, University Health Network, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Damber K Nirola
- Department of Neurology, University Health Network, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Chencho Dorji
- Department of Neurology, University Health Network, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Farrah J Mateen
- Neurological Clinical Research Institute, Massachusetts General Hospital,165 Cambridge St., Suite 600, Boston 02114, USA; Harvard Medical School, A-111, 25 Shattuck St., Boston 02114, USA.
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Abstract
There are numerous measures of perinatal quality endorsed by national agencies such as the National Quality Forum (NQF). The sheer number of metrics may lead to confusion about what these measures truly assess, and how to interpret variation in these measures across hospitals, health care systems, and geographic regions. This review presents a conceptual model for the numerous validated measures, an overview of the types of measures endorsed for perinatal quality by NQF in 2016, and potential measures absent from endorsement by these national bodies.
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Affiliation(s)
- Scott A Lorch
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, 2716 South Street, Room 10-251, Philadelphia, PA 19146, USA; PolicyLab, The Children's Hospital of Philadelphia, 2716 South Street, Room 10-251, Philadelphia, PA 19146, USA; Center for Perinatal and Pediatric Health Disparities Research, The Children's Hospital of Philadelphia, 2716 South Street, Room 10-251, Philadelphia, PA 19146, USA; Department of Pediatrics, The University of Pennsylvania School of Medicine, 2716 South Street, Room 10-251, Philadelphia, PA 19146, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA.
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21
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Ahmed RG, El-Gareib AW. Maternal carbamazepine alters fetal neuroendocrine-cytokines axis. Toxicology 2017; 382:59-66. [PMID: 28267586 DOI: 10.1016/j.tox.2017.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/14/2017] [Accepted: 03/02/2017] [Indexed: 12/15/2022]
Abstract
This study detected the impact of maternal carbamazepine (CBZ) on the fetal neuroendocrine-cytokines axis. 25 or 50mg/kg of CBZ was intraperitoneally administrated to pregnant albino rats from the gestation day (GD) 1 to 20. Both administrations of CBZ caused a hypothyroidism in dams and fetuses whereas the decreases in serum thyroxine (T4) and triiodothyronine (T3) and increases in serum thyrotropin (TSH) levels were highly significant (LSD; P <0.01) at GD 20 compared to untreated control dams. Also, both administrations had undesirable impacts on the maternofetal body weight, litter weight, survival of dams and fetuses, and their food consumption in comparison to the corresponding control. These administrations also elicited a reduction in fetal serum growth hormone (GH), interferon-γ (IFNγ), interleukins (IL-2 & 4) and prostaglandin E2 (PGE2) levels. Also, the elevation in fetal serum tumor necrosis factor-alpha (TNFα), transforming growth factor-beta (TGFβ), and interleukins (IL-1β & 17) levels was observed at embryonic day (ED) 20. Moreover, there were a cellular fragmentation, distortion, hyperemia, oedema and vacuolation in the fetal cerebellar cortex due to both maternal administrations. These developmental changes were dose-dependent. These novel results suggest that CBZ may act as a developmental immunoneuroendocrine disruptor.
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Affiliation(s)
- R G Ahmed
- Division of Anatomy and Embryology, Zoology Department, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt.
| | - A W El-Gareib
- Division of Anatomy and Embryology, Zoology Department, Faculty of Science, Cairo University, Egypt
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22
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Zash RM, Williams PL, Sibiude J, Lyall H, Kakkar F. Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges. Expert Opin Drug Saf 2016; 15:1501-1513. [PMID: 27552003 DOI: 10.1080/14740338.2016.1226281] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The use of antiretroviral therapy (ART) in pregnancy to prevent vertical HIV transmission has been one of the most successful public health programs in the last decade. As a result, an unprecedented number of women are taking ART at conception and during pregnancy. Given few randomized studies evaluating safety of different ART regimens in pregnancy, ongoing drug safety surveillance is critical. Areas covered: This review aims to provide a rationale for ART drug safety surveillance, describe changing patterns of ART use and summarize current surveillance efforts in both low-resource and high-resource settings. Additionally, biostatistical approaches to and challenges in analysis of observational surveillance data are discussed. Expert opinion: The global landscape of ART use in pregnancy is rapidly increasing and evolving. Any increase in adverse effects of in-utero exposure to ART has the potential to reduce the impact of improvements in infant morbidity and mortality gained from decreased vertical HIV transmission. ART drug safety surveillance should therefore be a critical piece of programs to prevent mother to child transmission in both high- and low-resource settings. Current surveillance efforts could be strengthened with long-term follow-up of exposed children, pooling of data across cohorts and standardized approaches to analysis.
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Affiliation(s)
- Rebecca M Zash
- a Division of Infectious Diseases , Beth Israel Deaconess Medical Center , Boston , MA , USA.,b Department of Immunology and Infectious Diseases , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,c Botswana Harvard AIDS Institute Partnership , Gaborone , Botswana
| | - Paige L Williams
- d Center for Biostatistics in AIDS Research , Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health
| | - Jeanne Sibiude
- e Groupe Hospitalier Cochin Port Royal , Université Paris Descartes , Paris , France.,f INSERM CESP 1018 , Le Kremlin Bicêtre , France
| | - Hermione Lyall
- g Consultant Paediatrician, Infectious Diseases , Imperial College Healthcare NHS Trust , London , UK
| | - Fatima Kakkar
- h Division of Infectious Diseases , Centre Hospitalier Universtaire Sainte-Justine, University of Montreal , Sainte-Justine , Canada
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Pelizzo G, Calcaterra V, Mannarino S, Moramarco LP, Leati G, Quaretti P. Aortopulmonary collateral artery in prenatal exposure to carbamazepine - endovascular therapy and technical considerations: a case report. J Med Case Rep 2015; 9:183. [PMID: 26311236 PMCID: PMC4551368 DOI: 10.1186/s13256-015-0645-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Aortopulmonary collateral arteries are an uncommon variant of alternative blood supply in cases of complex congenital heart disease. Although surgery may still be the classic approach for this condition, mini-invasive endovascular occlusion has been recently attempted as an alternative less traumatic procedure. Children born to women with epilepsy are at increased risk of congenital malformations. CASE PRESENTATION A cardiovascular malformation in a 6-year-old white boy with prenatal exposure to carbamazepine is described. At birth, he underwent atrial-ventricular septal defects repair. At 6 years of age, he was diagnosed to have an aberrant aortopulmonary artery from the descending aorta. He presented with recurrent respiratory infections and no cardiovascular signs, but there was associated right upper lobe hyperperfusion. Collateral percutaneous plug embolization was performed because of risk for cardiorespiratory infections, pulmonary hypertension and atrioventricular dilatation. The post-releasing control showed a complete occlusion of the aberrant artery. A chest radiogram and computed tomography showed normalization of vascular pattern of his right lung at 9-months follow-up. No complications and no respiratory infections in the first follow-up year were observed. A good growth gain was obtained. CONCLUSIONS Plug embolization in an aortopulmonary collateral artery is an interesting alternative to surgery and is suitable for children with minor congenital heart disease and without severe respiratory and/or cardiovascular symptoms. Management and long-term pediatric multidisciplinary follow-up is recommended. Prenatal exposure to carbamazepine could be considered in the pathogenesis and diagnosis of the malformation.
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Affiliation(s)
- Gloria Pelizzo
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia, P.le Golgi n.2, 27100, Pavia, Italy.
| | - Valeria Calcaterra
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. .,Department of Internal Medicine, University of Pavia, Pavia, Italy.
| | - Savina Mannarino
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
| | - Giovanni Leati
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
| | - Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
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Watila MM, Beida O, Kwari S, Nyandaiti NW, Nyandaiti YW. Seizure occurrence, pregnancy outcome among women with active convulsive epilepsy: one year prospective study. Seizure 2015; 26:7-11. [PMID: 25799895 PMCID: PMC4386020 DOI: 10.1016/j.seizure.2015.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/21/2014] [Accepted: 01/07/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the prevalence of active convulsive epilepsy, seizure frequency and the outcome of pregnancy amongst a cohort of pregnant women attending antenatal clinic (ANC) at two tertiary hospitals. METHODS An observational cohort study conducted at the University of Maiduguri Teaching Hospital and State Specialist Hospital, Northeast Nigeria. Pregnant women attending antenatal care were screened for previous history of active convulsive epilepsy, and recruited consecutively according to a specified protocol. A standardized questionnaire was administered to record pregnancy history, nature of epilepsy and treatments received. They were followed-up during the course of the pregnancy based on the ANC schedule up to delivery. The outcome of pregnancies was recorded. RESULTS A total of 7063 pregnant women were screened, of whom 103 (1.46%) subjects had at least a past history of seizure. Seventy-eight (1.10%) had a past history of seizure(s) from eclampsia and 23 (0.33%) pregnant subjects recruited were identified to have active convulsive epilepsy. The unadjusted prevalence of active convulsive epilepsy in pregnant women was found to be 3.33 per 1000 (95% CI: 2.1-4.8). Subjects who had a history of head injury and encephalitis were more likely to have seizures during pregnancy. (P=0.013 and P=0.041). Those who had recurrent seizures within the last six months before recruitment were more likely to have a negative pregnancy outcome (P=0.043). CONCLUSION Our study found a prevalence of active epilepsy of 3.33 per 1000 among pregnant women, with about one percent having a past history of seizure from eclampsia.
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Affiliation(s)
- Musa Mamman Watila
- Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414 Maiduguri, Borno state, Nigeria.
| | - Omeiza Beida
- Federal Neuropsychiatric Hospital, Maiduguri PMB 1322, Borno State, Nigeria
| | - Shiktra Kwari
- Department of Gynaecology and Obstetrics, University of Maiduguri Teaching Hospital, PMB 1414 Maiduguri, Borno state, Nigeria
| | - Na'awurti Williams Nyandaiti
- Department of Statistics, School of Nursing, University of Maiduguri Teaching Hospital, PMB 1414 Maiduguri, Borno state, Nigeria
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Withholding the choice of sodium valproate to young women with generalised epilepsy: Are we causing more harm than good? Seizure 2015; 24:127-30. [DOI: 10.1016/j.seizure.2014.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/15/2014] [Accepted: 08/17/2014] [Indexed: 11/18/2022] Open
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Polepally AR, Pennell PB, Brundage RC, Stowe ZN, Newport DJ, Viguera AC, Ritchie JC, Birnbaum AK. MODEL-BASED LAMOTRIGINE CLEARANCE CHANGES DURING PREGNANCY: CLINICAL IMPLICATION. Ann Clin Transl Neurol 2014; 1:99-106. [PMID: 24883336 PMCID: PMC4038031 DOI: 10.1002/acn3.29] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective The objective of the study was to characterize changes in the oral clearance (CL/F) of lamotrigine (LTG) over the course of pregnancy and the postpartum period through a model-based approach incorporating clinical characteristics that may influence CL/F, in support of developing clinical management guidelines. Methods Women receiving LTG therapy who were pregnant or planning pregnancy were enrolled. Maternal blood samples were collected at each visit. A pharmacokinetic analysis was performed using a population-based, nonlinear, mixed-effects model. Results A total of 600 LTG concentrations from 60 women (64 pregnancies) were included. The baseline LTG CL/F was 2.16 L/h with a between-subject variability of 40.6%. The influence of pregnancy on CL/F was described by gestational week. Two subpopulations of women emerged based on the rate of increase in LTG CL/F during pregnancy. The gestational age-associated increase in CL/F displayed a 10-fold higher rate in 77% of the women (0.118 L/h per week) compared to 23% (0.0115 L/h per week). The between-subject variability in these slopes was 43.0%. The increased CL/F at delivery declined to baseline values with a half-life of 0.55 weeks. Interpretation The majority of women had a substantial increase in CL/F from 2.16 to 6.88 L/h by the end of pregnancy, whereas 23% of women had a minimal increase. An increase in CL/F may correspond to decreases in LTG blood concentrations necessitating the need for more frequent dosage adjustments and closer monitoring in some pregnant women with epilepsy. Postpartum doses should be tapered to preconception dose ranges within 3 weeks of delivery.
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Affiliation(s)
- Akshanth R Polepally
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Page B Pennell
- Department of Neurology and Division of Women's Health at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard C Brundage
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Zachary N Stowe
- Department of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - D Jeffrey Newport
- Departments of Psychiatry and Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio ; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - James C Ritchie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia ; Department of Pathology, Emory University School of Medicine
| | - Angela K Birnbaum
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
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Hughes C, Waters M, Allen D, Obasanjo I. Translational toxicology: a developmental focus for integrated research strategies. BMC Pharmacol Toxicol 2013; 14:51. [PMID: 24079609 PMCID: PMC3850030 DOI: 10.1186/2050-6511-14-51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/23/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Given that toxicology studies the potential adverse effects of environmental exposures on various forms of life and that clinical toxicology typically focuses on human health effects, what can and should the relatively new term of "translational toxicology" be taken to mean? DISCUSSION Our assertion is that the core concept of translational toxicology must incorporate existing principles of toxicology and epidemiology, but be driven by the aim of developing safe and effective interventions beyond simple reduction or avoidance of exposure to prevent, mitigate or reverse adverse human health effects of exposures.The field of toxicology has now reached a point where advances in multiple areas of biomedical research and information technologies empower us to make fundamental transitions in directly impacting human health. Translational toxicology must encompass four action elements as follows: 1) Assessing human exposures in critical windows across the lifespan; 2) Defining modes of action and relevance of data from animal models; 3) Use of mathematical models to develop plausible predictions as the basis for: 4) Protective and restorative human health interventions. The discussion focuses on the critical window of in-utero development. SUMMARY Exposure assessment, basic toxicology and development of certain categories of mathematical models are not new areas of research; however overtly integrating these in order to conceive, assess and validate effective interventions to mitigate or reverse adverse effects of environmental exposures is our novel opportunity. This is what we should do in translational toxicology so that we have a portfolio of interventional options to improve human health that include both minimizing exposures and specific preventative/restorative/mitigative therapeutics.
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Affiliation(s)
- Claude Hughes
- Quintiles, Inc, North Carolina State University; Wake Forest University; Duke University Medical Center, Morrisville, NC, USA
| | - Michael Waters
- Integrated Laboratory Systems, Inc, Research Triangle Park, Durham, NC, USA
| | - David Allen
- Integrated Laboratory Systems, Inc, Research Triangle Park, Durham, NC, USA
| | - Iyabo Obasanjo
- Advanced Leadership Fellow, Harvard University, Cambridge, MA, USA
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