Terapijski izazovi liječenja epilepsije u trudnoći

master's thesis

• Title (english): Therapeutic challenges of epilepsy treatment in pregnancy
• Author: Lukrecia Rajković
• Mentor: Lidija Bach-Rojecky (mentor)
• Committee member: Lidija Bach-Rojecky (predsjednik povjerenstva)
• Committee member: Monika Barbarić (član povjerenstva)
• Committee member: Iva Mucalo (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of pharmacology); Zagreb
• Defense date and country: 2024-07-19, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Epilepsija spada u jednu od najučestalijih bolesti središnjeg živčanog sustava (SŽS), s oko 1 % zahvaćene populacije. Žene oboljele od epilepsije u reproduktivnoj dobi koje žele ostati trudne predstavljaju visokorizičnu skupinu pacijenata koje su izazov liječnicima prilikom propisivanja ispravne terapije za kontrolu bolesti. U žena s dijagnozom epilepsije preporučeno je planiranje trudnoće, kako bi se na vrijeme prilagodila terapija, odbarao pravi lijek, u pravoj (učinkovitoj i sigurnoj) dozi. Pritom se prilikom odabira lijeka u obzir uzimaju različiti čimbenici, posebice dokazi o sigurnosti primjene lijekova tijekom trudnoće, kao i podaci o štetnom djelovanju na majku i dijete. Cilj ovog preglednog rada je istražiti sigurnost, djelotvornost, prednosti i nedostatke uporabe pojedinih antiepileptika tijekom trudnoće, kao i prikazati povezanost s kongenitalnim malformacijama i drugim rizicima tijekom embrio-fetalnog razvoja, tijekom poroda te kasnijeg razvoja novorođenčeta. Primjena antiepileptika u trudnoći može dovesti niza neželjenih učinaka, od kojih su velike i male urođene malformacije s teškim posljedicama za funkcioniranje i kasniji razvoj djeteta. Lijekovi za koje se bilježi najveći rizik nastanka štetnog učinka za fetus su valproična kiselina, fenitoin, fenobarbital, karbamazepin, topiramat i potrebno ih je tijekom trudnoće izbjegavati, osobito u prvom tromjesečju. Među najpropisivanijim lijekovima, ujedno i onima koji pokazuju najmanji rizik za kongenitalne malformacije i druge nuspojave izdvajaju se levetiracetam, brivaracetam te lamotirigin. Usprkos rizicima, uz pravilan pristup pacijenticama, redovito praćenje koncentracija lijekova tijekom trudnoće te odgovarajuću suplementaciju folnom kiselinom i vitaminom K, većina žena trudnoću privede kraju uz dobru kontrolu bolesti i sa željenim ishodom trudnoće.

Abstract (english)

Epilepsy is one of the most common diseases of the central nervous system (CNS), affecting about 1% of the population.
Women suffering from epilepsy of reproductive age who want to become pregnant represent a high-risk group of patients
who are a challenge for doctors when prescribing the correct therapy to control the disease. For women diagnosed with
epilepsy, pregnancy planning is recommended, in order to adjust the therapy in time, choose the right medicine, in the
right (effective and safe) dose. Various factors are taken into account when choosing a drug, especially evidence on the
safety of drug use during pregnancy, as well as data on adverse effects on the mother and child. The aim of this review
is to investigate the safety, effectiveness, advantages and disadvantages of the use of certain antiepileptic drugs during
pregnancy, as well as to show the connection with congenital malformations and other risks during embryo-fetal
development, during childbirth and later development of the newborn. The use of antiepileptic drugs during pregnancy
can lead to a number of unwanted effects, including large and small congenital malformations with serious consequences
for the functioning and subsequent development of the child. Medicines for which the greatest risk of adverse effect on
the fetus is noted are valproic acid, phenytoin, phenobarbital, carbamazepine, topiramate and should be avoided during
pregnancy, especially in the first trimester. Levetiracetam, brivaracetam and lamotrigine stand out among the most
prescribed drugs, as well as those that show the lowest risk for congenital malformations and other side effects. Despite
the risks, with a proper approach to patients, regular monitoring of drug concentrations during pregnancy and adequate
supplementation with folic acid and vitamin K, most women bring their pregnancy to an end with good disease control
and the desired pregnancy outcome.

• Keywords: epilepsija; antiepileptici; trudnoća; kongenitalne malformacije; teratogenost
• Keywords (english): epilepsy; antiepileptic drugs; pregnancy; congenital malformations; teratogenicity
• Language: croatian
• URN:NBN: urn:nbn:hr:163:859263
• Study programme: Title: Pharmacy - integrated undergraduate and graduate - university study; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: sveučilišni magistar farmacije (sveučilišni magistar farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-09-27 12:07:58