Gebelik ve Epilepsi
Özet
Epilepsi, genel nüfusun yaklaşık %1'ini etkileyen ve gebeliklerin en az yarısı planlanmamış olarak gerçekleşen önemli bir nörolojik durumdur. Planlanmamış gebelikler olumsuz maternal ve fetal sonuçlar doğurabildiği için doğurganlık çağındaki kadınlarda aile planlaması ve perikonsepsiyonel dönemde folik asit takviyesi (0.4-4 mg/gün) kritik önem taşır. Enzim indükleyici antiepileptik ilaçlar (AEİ) hormonal kontraseptiflerin etkinliğini azalttığından, bu hastaların yüksek doz östrojen kullanması veya rahim içi araçları tercih etmesi önerilir. Gebelikte nöbetleri önlemek amacıyla AEİ kullanımına devam edilmelidir; ancak teratojenik riskleri azaltmak için monoterapiye ve en düşük doza öncelik verilmelidir. Valproat ve topiramat gibi ilaçlar yüksek major konjenital malformasyon (spina bifida, yarık damak) ve kognitif gerilik riski taşıdığından gebelikte kullanımlarından kaçınılmalıdır. Buna karşın, lamotrijin ve levetirasetam muhtemelen düşük riskli gruptadır. Gebelik esnasında artan metabolizma nedeniyle AEİ serum seviyeleri %40-70 oranında düşebileceğinden yakın doz takibi gereklidir. Doğum esnasında nöbet eşiğini düşüren meperidin analjezisinden kaçınılmalı, akut nöbetlerde kısa etkili benzodiazepinler kullanılmalıdır. Yenidoğanda intrakranial kanamayı önlemek için doğumda K vitamini uygulanmalıdır. Postpartum dönemde uykusuzluk nöbetleri tetikleyebileceğinden sosyal destek önemlidir ve AEİ kullanan anneler süt yoluyla geçiş oranları düşük olduğundan emzirme konusunda desteklenmelidir.
Epilepsy affects approximately 1% of the general population, and at least half of the pregnancies occur unplanned. Since unplanned pregnancies can lead to adverse maternal and fetal outcomes, family planning and periconceptional folic acid supplementation (0.4-4 mg/day) are of critical importance for women of childbearing age. Because enzyme-inducing antiepileptic drugs (AEDs) reduce the effectiveness of hormonal contraceptives, these patients are advised to use high-dose estrogen or prefer intrauterine devices. AED use must be continued during pregnancy to prevent seizures; however, priority should be given to monotherapy and the lowest possible dose to minimize teratogenic risks. Drugs such as valproate and topiramate carry a high risk of major congenital malformations (spina bifida, cleft palate) and cognitive decline, and thus their use should be avoided during pregnancy. Conversely, lamotrigine and levetiracetam are categorized in the probably low-risk group. Close dose monitoring is required during pregnancy as increased metabolism can decrease AED serum levels by 40-70%. Meperidine analgesia, which lowers the seizure threshold, should be avoided during labor, and short-acting benzodiazepines should be used for acute seizures. To prevent intracranial hemorrhage in the newborn, vitamin K should be administered at birth. In the postpartum period, social support is essential as sleep deprivation can trigger seizures, and breastfeeding mothers should be supported regardless of their AED use due to low drug transfer rates into breast milk.
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