Zusammenfassung
Epilepsie ist eine häufige Erkrankung. Epilepsiekranke Frauen mit Kinderwunsch haben einen erhöhten Beratungsbedarf bezüglich einer Schwangerschaft. Die meisten dieser Frauen bekommen gesunde Kinder. Dennoch ist die Fehlbildungsrate ihrer Kinder erhöht. Günstig ist eine so niedrig wie möglich dosierte Monotherapie, idealerweise mit Lamotrigin oder Levetiracetam. Nichtempfehlenswert ist Valproat. Polytherapien erhöhen das Risiko für Fehlbildungen. Während der Schwangerschaft sollte insbesondere unter Lamotrigin- und Oxcarbazepingabe der Serumspiegel engmaschig kontrolliert werden, da es häufig zu einem Abfall der Serumkonzentration und hierdurch zu Anfallsrezidiven kommt. Bereits vor der Empfängnis sollten Frauen, die Antiepileptika einnehmen, täglich 5 mg Folsäure einnehmen. Die Epilepsie ist kein Grund für einen Kaiserschnitt. Die Geburt sollte aber in einem Haus mit Neonatologie und Neurologie erfolgen. Stillen ist auch unter Antiepileptika zu empfehlen. Nach der Geburt sollte auf Überdosierungserscheinungen bei Mutter der geachtet werden, insbesondere wenn sie Lamotrigin, Oxcarbazepin oder Levetiracetam einnimmt.
Abstract
Epilepsy is a common disease. Women with epilepsy who want to become pregnant often have concerns regarding the baby’s health and need special counseling. Most of these women will have healthy children; nevertheless the malformation rate is elevated. Ideally, antiepileptic drugs should be taken in monotherapy and with the lowest possible dose. According to the current literature the drugs causing the lowest malformation rates are lamotrigine and levetiracetam. Valproate should be avoided. Valproate-associated malformation rates are dose-dependant but if unavoidable, doses lower than 1,000 mg daily should be given. Polytherapy is associated with higher malformation rates. During pregnancy serum levels of lamotrigine and oxcarbazepine should be closely monitored because serum concentrations fall during pregnancy often resulting in seizure recurrence. Even before conception women on antiepileptic drugs should take 5 mg folic acid daily. Epilepsy per se is not an indication for a caesarean section; however, women should give birth in a hospital with departments of neurology and neonatology. Breast feeding is recommended. The mother should be monitored for signs of an overdose especially when taking oxcarbazepine, lamotrigine or levetiracetam.
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Bengner, M., Schmitz, B. Frauen mit Epilepsie vor und während der Schwangerschaft. Z. Epileptol. 26, 154–159 (2013). https://doi.org/10.1007/s10309-013-0306-6
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DOI: https://doi.org/10.1007/s10309-013-0306-6