Pregnancy, epilepsy, and anticonvulsants

Topiramate treatment during adolescence induces short and long-term alterations in the reproductive system of female rats

Topiramate (TPM) is an antiepileptic drug used for treating epilepsy in children, and migraine in teenagers. In this context, preclinical studies with adult female rats observed reproductive system abnormalities following treatment with TPM. Additionally, exposure to endocrine disruptors during developmental plasticity periods, such as childhood and adolescence, may influence characteristics in the adult individual. This study evaluated whether treatment with TPM during developmental periods influences the reproductive system of female rats either immediately or in adult life. Female Wistar rats were treated with TPM (41 mg/Kg/day) by oral gavage from postnatal day (PND) 16-28, or PND 28-50, which correspond to childhood and adolescence, respectively, and euthanized either 24 h after the final administration or during adulthood. Treatment with TPM during adolescence induced short-term increase in uterus and ovary weights and reduction in endometrial stroma thickness. Adult animals treated during adolescence displayed reduced primordial ovarian follicles' numbers, and increased primary and pre-antral ovarian follicles' numbers. Treatment during childhood induced no short or long-term differences. These results indicate TPM treatment during adolescence is capable of inducing short and long-term alterations on the reproductive system of female Wistar rats.

Female sex steroids and epilepsy: Part 2. A practical and human focus on catamenial epilepsy

Catamenial epilepsy is the best described and most researched sex steroid-specific seizure exacerbation. Yet despite this there are no current evidence-based treatments, nor an accepted diagnostic tool. The best tool we currently have is tracking seizures over menstrual cycles; however, the reality of tracking seizures and menstrual cycles is fraught with challenges. In Part 1 of this two-part review, we outlined the often complex and reciprocal relationship between seizures and sex steroids. An adaptable means of tracking is required. In this review, we outline the extent and limitations of current knowledge on catamenial epilepsy. We use sample data to show how seizure exacerbations can be tracked in short/long and even irregular menstrual cycles. We describe how seizure severity, an often overlooked and underresearched form of catamenial seizure exacerbation, can also be tracked. Finally, given the lack of treatment options for females profoundly affected by catamenial epilepsy, Section 3 focuses on current methods and models for researching sex steroids and seizures as well as limitations and future directions. To permit more informative, mechanism-focused research in humans, the need for both a consistent classification of catamenial epilepsy and an objective biomarker is highlighted.

Knowledge of neurologists and gynaecologists regarding reproductive and maternity issues in women with epilepsy

Background: Epilepsy is one of the most common neurological disorders, with more than 400,000 individuals in Poland (about 1% of the population) affected. Epilepsy complicates approximately 0.5% of pregnancies. Objective: To determine the level of knowledge that neurologists and gynaecologists have about reproductive and maternity issues for women with epilepsy. Material and methods: This study included 141 neurologists and physicians undergoing specialist training in neurology as well as 72 gynaecologists and physicians undergoing specialist training in gynaecology. A validated questionnaire was used to survey these neurologists and gynaecologists, who worked in Silesia Province. Results: In the group of physicians advising on contraception, significantly (p=0.003) more gynaecologists than neurologists recommended hormonal birth control. Significantly more (p=0.031) neurologists than gynaecologists believed that monotherapy with antiepileptic medications should be aimed for before a planned pregnancy in women with epilepsy. More than a half of the surveyed physicians (56.8%) believed that pregnant women with epilepsy can have a natural delivery. Conclusions: On the basis of these results, we have concluded that gynaecologists and, to a lesser extent, neurologists should have more extensive knowledge regarding reproductive and maternity issues for women with epilepsy. We further propose that close collaboration between neurologists and gynaecologists in the care of epileptic women is necessary.

Towards a better comprehension of interactions in the crystalline N-acetylbenzylamine and its sulphur analogue N-benzyl-ethanethioamide. IR, Raman, DFT studies and Hirshfeld surfaces analysis

This paper presents the investigation results of the polarized IR spectra of the hydrogen bond in crystals of N-acetylbenzylamine and its sulphur analogue N-benzyl-ethanethioamide. The spectra were measured at 298 and 77 K by a transmission method, with the use of polarized light. The Raman spectroscopy, Hirshfeld surfaces analysis and DFT studies have been also reported. Theoretical calculations of the isolated molecule were performed by using density functional theory (DFT) method at B3LYP/6-311(d,p), B3LYP/6-311++G(d,p) and B3LYP/6-311++G(3df,2pd) basis set levels. The geometrical parameters of analyzed compounds are in good agreement with the XRD experiment. The vibrational frequencies were calculated and subsequently values have been compared with the experimental Infrared and Raman spectra. It has been shown that the observed and calculated frequencies are found to be in good agreement, as well as the analysis of the Hirshfeld surface has been well correlated to the spectroscopic studies. Additionally, the highest occupied molecular orbital energy (E_HOMO), lowest unoccupied molecular orbital energy (E_LUMO), the energy gap between E_HOMO and E_LUMO (ΔE_HOMO-LUMO), molecular electrostatic potential and global reactivity descriptors viz. chemical potential, global hardness and electrophilicity have been calculated. In N-acetylbenzylamine the presence of the N-benzylamide fragment is essential for activity.

Which information on women's issues in epilepsy does a community pharmacist need to know? A Delphi consensus study

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).

Absence epileptic activity in Wistar Albino Glaxo Rijswijk rat mothers

Absence epileptic activity was analyzed during pregnancy, the postpartum period and after weaning to establish alterations of seizures throughout the reproductive cycle. Wistar Albino Glaxo Rijswijk (WAG/Rij) rats were used in the study as a model of absence epilepsy and because their seizures do not interfere with rearing offspring. The number of spike-wave discharges (SWDs) was gradually elevated from the 19th pregnancy day to delivery. Meanwhile, the characteristics of individual SWDs did not change suggesting that SWD generation remained the same. In the postpartum and postweaning periods, the number of SWDs was not increased in the absence of pups. However, returning the pups to mothers resulted in a markedly elevated number of SWDs for 1h. If pups were taken away after 30min, the number of SWDs dropped immediately suggesting that the presence of pups increased the SWD number. The time mothers spent with the litter and in kyphosis suckling posture were in correlation with their SWD number further suggesting the importance of interaction with pups in SWD induction. Suckling elevates prolactin levels but surprisingly, its intracerebroventricular injection markedly reduced SWD number in suckled WAG/Rij mothers suggesting that the SWD-inducing effect of suckling is not mediated by prolactin. Rather, the elevated prolactin level may provide some protection against pro-epileptic effects of suckling. In conclusion, we first identified periods within the reproductive cycle with increased absence epileptic activity, implying that more attention should be devoted to epileptic activity changes in mothers.