Epilepsija i trudnoća

master's thesis

• Title (english): Epilepsy and pregnancy
• Author: Nika Benjak
• Mentor: Željka Petelin Gadže (mentor)
• Committee member: Zdravka Poljaković (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Željka Petelin Gadže (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Iako je epilepsija danas jedna od najčešćih neuroloških bolesti, i dalje predstavlja značajan medicinski i javnozdravstveni problem, posebice u specifičnih skupina bolesnika kao što su trudnice. Trudnoća je sama po sebi razdoblje u kojem se mijenja i fiziologija i psihologija žene. Kad se tome pridruži teška bolest, jasno je koliko je zahtjevno održavati bolest pod kontrolom te istovremeno ne štetiti samoj ženi i djetetu. Trudnice sa epilepsijom svrstavamo u rizične skupine te zbog tog zahtijevaju pojačan nadzor tijekom tog razdoblja, i od ginekologa i epileptologa. Unaprijed planirana trudnoća, odgovarajuća terapija koja se tijekom trudnoće nipošto ne smije prekidati te učestale kontrole, trebale bi rezultirati urednom trudnoćom i porođajem, bez ikakvih komplikacija. Glavni cilj antiepileptične terapije u trudnica je postići ravnotežu između potpune kontrole epileptičnih napadaja sa minimalnom dozom lijeka te potencijalnih teratogenih učinaka antiepileptičnih lijekova. Trudnicama sa epilepsijom treba naglasiti da u velikom postotku trudnoća prolazi uredno, a učestalost kongenitalnih malformacija ovisi o tipu, dozi i broju antiepileptika. Valproati bi se zbog svog teratogenog potencijala svakako trebali izbjegavati, a preporučuju se lamotrigin, karbamazepin, levetiracetam te okskarbazepin zbog svog minimalnog učinka na plod. Preporučeno je tijekom trudnoće uzimati folnu kiselinu kako bi se prevenirao nastanak defekata neuralne cijevi te u zadnjem mjesecu trudnoće vitamin K zbog sprječavanja neonatalne hemoragije nakon porođaja. Dojenje se svakako preporučuje zbog svih pozitivnih učinaka na majku i dijete sa praćenjem serumskih koncentracija lijekova u djeteta ako je to potrebno.

Abstract (english)

Although epilepsy is one of the most common neurological diseases today, it still represents a significant medical and public health issue, especially in specific groups of patients such as pregnant women. Pregnancy, itself, is a period in which women's physiology and psychology changes. When pregnancy is accompanied by a severe disease, it is unambiguous how difficult it is to keep the disease under control and not harm the woman nor her child at the same time. Pregnant women with epilepsy are a high-risk group and because of this, they require constant monitoring during pregnancy, both from gynecologists and epileptologists. Pre-planned pregnancy, receiving appropriate therapy during pregnancy and regular frequent medical examinations should result in a normal pregnancy and birth without any complications. The main goal of anti-epileptic therapy in pregnant women is to achieve a balance between complete control of epileptic seizures with minimal dosage of the drug and potential teratogenic effects of anti-epileptic drugs (AEDs). It should be stressed to pregnant women that a high percentage of pregnancies are considered to be normal and do not have complications whereas the frequency of congenital malformations depends on the type, dosage and number of anti-epileptics. Valproates should be avoided because of its teratogenic potential. Lamotrigine, carbamazepine, levetiracetam and oxcarbazepine are recommended due to their minimal effect on the fetus. Taking folic acid is highly recommended during pregnancy in order to prevent the formation of neural tube defects and in the last month of pregnancy vitamin K should be taken to prevent neonatal hemorrhage after delivery. Breastfeeding is also highly recommended considering the fact that it results in various positive effects on the mother and the child but monitoring serum concentrations of the drugs in the child is sometimes necessary.

• Keywords: epilepsija; trudnoća; antiepileptični lijekovi; teratogenost
• Keywords (english): epilepsy; pregnancy; antiepileptic drugs; teratogenicity
• Language: croatian
• URN:NBN: urn:nbn:hr:105:902519
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-20 13:43:13