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Klinische Neurophysiologie 2012; 43(02): 138-143
DOI: 10.1055/s-0032-1312671
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© Georg Thieme Verlag KG Stuttgart · New York

Frauen mit Epilepsie: 7 wichtige Aspekte

Women with Epilepsy: 7 Important Aspects
S. Pirker
1   2. Neurologische Abteilung, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel und Karl Landsteiner Institut für Klinische Epilepsieforschung und Kognitive Neurologie, Wien
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Publication Date:
22 June 2012 (online)

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Zusammenfassung

Weibliche Geschlechtshormone scheinen eine Rolle in der Epileptogenese zu spielen. Ein Teil der Frauen mit Epilepsie leidet unter zyklusabhängigen Anfällen. Die Fertilität von Frauen mit Epilepsie ist geringer als jene der Allgemeinbevölkerung. Antiepileptika haben einen Einfluss auf weibliche Geschlechtshormone. Für einige Antiepileptika wurden Wechselwirkungen mit hormonellen Kontrazeptiva beschrieben. So schwanken z. B. die Plasmaspiegel von Lamotrigin während des normalen Zyklus bzw. unter Einnahme von oralen Kontrazeptiva. Umgekehrt können Enzym-induzierende Antikonvulsiva (Carbamazepin, Eslicarbazepin, Oxcarbazepin, Phenytoin, Primidon) die Wirksamkeit von oralen Kontrazeptiva deutlich abschwächen. Ein polyzystisches Ovar-Syndrom wird häufiger bei Frauen, die Valproinsäure einnehmen, diagnostiziert. 50% der Patientinnen unter einer antiepileptischen Dauermedikation leidet unter einer Osteopathie. Das Risiko einer Malformation ist bei Kindern von Müttern mit Epilepsie, die Antiepileptika einnehmen, etwa doppelt so hoch wie bei Kindern von gesunden Müttern. Die häufigsten Malformationen nach Antiepileptika-Exposition des Kindes während der Schwangerschaft betreffen das Herz. Das Risiko einer Malformation dürfte besonders hoch bei Valproinsäure-Tagesdosen von über 1 000 mg sein. Im Gegensatz dazu legen die Ergebnisse einer rezenten Populations-basierten Studie nahe, dass unter folgenden neueren Antikonvulsiva kein erhöhtes Risiko für schwere kindliche Malformationen bestehen dürfte: Lamotrigin, Oxcarbazepin, Topiramat, Gabapentin und Levetiracetam. Kinder, deren Mütter während der Schwangerschaft mit Valproinsäure behandelt wurden, wiesen geringere IQ Werte auf als Kinder, deren Mütter ein anderes Antiepileptikum einnahmen. Zur Verhinderung von Neuralrohrdefekten sollte bei allen gebärfähigen Frauen mit Epilepsie unbedingt eine Folsäure-Prophylaxe erfolgen.

Abstract

Sex steroid hormones are thought to play a role in epileptogenesis. Thus, seizure patterns may fluctuate with the menstrual cycle. In women with epilepsy, fertility is lower compared with the general population. Antiepileptic drugs influence fertility and some of them interact with oral contraceptives. Plasma levels of lamotrigine, for example, vary during the regular menstrual cycle as well as in women who take hormonal contraceptives. Conversely, enzyme-inducing antiepileptic drugs (carbamazepine, eslicarbazepine, oxcarbazepine, phenytoin, primidon) influence the effectivity of oral contraceptives. A polycystic ovary syndrome is frequent in women with epilepsy under treatment with valproic acid. 50% of women with epilepsy receiving antiepileptic drugs suffer from osteopathy. Children exposed to antiepileptic drugs during pregnancy have a higher risk for malformations than unexposed children. In this population, cardiac defects are the most common form of malformations. Treatment with valproic acid, especially in daily doses exceeding 1 000 mg, carries a particularly high risk for congenital malformations. In contrast, according to a population based trial, the risk for malformations may not be increased with the new antiepileptic drugs gabapentin, lamotrigine, levetiracetam, oxcarbazepine and topiramate. Children exposed to valproic acid during pregnancy had lower IQ levels than children exposed to other antiepileptic drugs. Folic acid supplementation is recommended in all women with epilepsy in child-bearing age to prevent neural-tube defects.

Schlüsselwörter

Schwangerschaft - Frauen mit Epilepsie - Anfälle - weiblich

Key words

pregnancy - women with epilepsy - seizure - female
 

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