Fehlbildungsrisiko bei Antiepileptika

B. Wandschneider; V. Gaus; B. Schmitz

doi:10.1055/s-0038-1628747

Nervenheilkunde, Table of Contents

Nervenheilkunde 2010; 29(04): 199-203
DOI: 10.1055/s-0038-1628747

Epilepsie

Schattauer GmbH

Fehlbildungsrisiko bei Antiepileptika

Aktueller StandTeratogenesis of anti-epileptic drugsAn update

B. Wandschneider

¹Klinik für Neurologie, Charité Campus Virchow Klinikum, Berlin

²Klinik für Neurologie, Vivantes Humboldt-Klinikum, Berlin

,

V. Gaus

¹Klinik für Neurologie, Charité Campus Virchow Klinikum, Berlin

,

B. Schmitz

¹Klinik für Neurologie, Charité Campus Virchow Klinikum, Berlin

²Klinik für Neurologie, Vivantes Humboldt-Klinikum, Berlin

› Author Affiliations

Abstract

Zusammenfassung

Obwohl die meisten Schwangerschaften unter Antiepileptika komplikationslos verlaufen, ist eine In-utero-Exposition mit Antikonvulsiva mit einem erhöhten Fehlbildungsrisiko assoziiert. Um eine sinnvolle Abwägung des Fehlbildungsrisikos im Vergleich zu möglichen Anfallsrezidiven bei Umstellung oder Reduktion der Antiepileptika treffen zu können, sind in den letzten Jahren mehrere prospektive Schwangerschaftsregister geschaffen worden, die eine systematische und statistisch aussagekräftige Untersuchung des Fehlbildungsrisikos erlauben. Als Risikofaktoren erhöhter Teratogenität gelten in erster Linie die Polytherapie und die Therapie mit Valproat. Dabei ist der Valproateffekt dosisabhängig. Lamotrigin und Carbamazepin scheinen zu den günstigeren Präparaten zu zählen. Bezüglich eines spezifischen Fehlbildungsprofils der neuen Antiepileptika können bei kleinen Fallzahlen keine verlässlichen Aussagen getroffen werden. Zusätzlich wurde in den letzten Jahren der Verdacht einer negativen Auswirkung auf die neurokognitive Entwicklung insbesondere bei In-utero-Exposition mit Valproat diskutiert.

Summary

Although most children born to women with epilepsy on anticonvulsive medication are healthy, in utero anti-epileptic exposure is associated with an increased risk of congenital malformations. Trying to balance the risk of seizure recurrence and potential malformations, several large prospective pregnancy registries have been founded to allow a systematic analysis of malformation risks under anti-epileptics. Several studies conclude that in utero exposure to valproate and polytherapy are associated with increased teratogenic risks whereas lamotrigine and carbamazepine monotherapies seem to be rather safe. Concerning newer generation drugs sample sizes tend to be too small to draw final conclusions. Recently, concerns about impaired neuro-developmental outcomes under valproate, phenobarbital, phenytoin monotherapy and polytherapy have been raised.

Schlüsselwörter

Antiepileptika - Epilepsie - Schwangerschaft - Fehlbildungsrisiko

Keywords

Anti-epileptic - pregnancy - epilepsy - teratogenesis

Full Text

References

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