ANTIEPILEPTIC DRUGS IN PREGNANCY: DIFFERENCES IN UK AND USA
Abstract number :
2.332
Submission category :
Year :
2003
Submission ID :
2087
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Kimford Meador, David Chadwick, Jill Clayton-Smith, Page Pennell, Joyce Liporace, Laura Kalayian, NEAD Study Group Neurology, Georgetown University, Washington, DC; Neurological Sciences, The Walton Centre for Neurology & Neurosurgery, Liverpool, United K
The differential utilization of AEDs in pregnant women with epilepsy is unknown. Selection of antiepileptic drugs (AEDs) in women with epilepsy is influenced by added concerns such as teratogenesis. Although several of the newer AEDs have better teratogenic profiles in animals, the differential risks of both new and old AEDs in humans are unknown. Given these uncertainties, the present use of AEDs in this population would be of interest.
Centers in the UK (2) and USA (28) are conducting prospective studies enrolling pregnant women with epilepsy in order to follow their children to determine if there are differential effects of AEDs on behavioral neurodevelopment. The screening and enrollment data from these studies provide information on the present utilization of AEDs in pregnant women at tertiary epilepsy centers.
In the UK, 220 mother/child pairs have been enrolled: monotherapy 140 (64%), polytherapy 34 (15%), no AED 46 (21%). Monotherapy AEDs in UK included: Carbamazepine 54 (39%), Lamotrigine 24 (17%), Phenytoin 7 (5%), Valproate 51 (36%), Other 4 (3%). In the USA, 313 mother/child pairs screened included: monotherapy 212 (68%), polytherapy 60 (19%), no AED 41 (13%). Monotherapy AEDs in USA included: Carbamazepine 63 (30%), Lamotrigine 61 (29%), Phenytoin 34 (16%), Valproate 23 (11%), Phenobarbital 10 (5%), Topiramate 7 (3%), Oxcarbazepine 6 (3%), and Other 8 (4%).
The choice of AED in pregnant women differs in the UK and USA. Of the new AEDs, lamotrigine is the most commonly used at tertiary epilepsy centers. The regional differences likely result from inadequate scientific evidence for AED choice in this population.
[Supported by: NINDS/NIH and UK Epilepsy Research Foundation]