PHARMACOTHERAPY OF EPILEPSY IN WOMEN: CURRENT STATUS, FUTURE DIRECTIONS, AND CHALLENGES
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Date
2022-03-31
Authors
Zaid, Lina
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Publisher
جامعة النجاح الوطنية
Abstract
Background: This study was conducted in two phases: a systematic review and a qualitative study. The systematic review was conducted to evaluate concentrations of antiepileptic drugs (AEDs) in breastmilk of lactating women with epilepsy (WWE). The qualitative study was conducted to explore the perspectives of neurologists, gynecologists, psychiatrists, internists, and pharmacists about caring for WWE in Palestine.
Methods: In the systematic review, the databases: MEDLINE/PubMed, EMBASE, CINAHL/EBSCO, COCHRANE, SpringerLink, ScienceDirect, Summon, WHO International Clinical Trials Registry Platform, and SCOPUS were systematically searched. In the qualitative study, a purposive sampling technique was used to recruit the participants for the qualitative study. Semi-structured in-depth interviews were conducted neurologists (n = 6), gynecologists (n = 5), psychiatrists (n = 3), internist (n = 1), and clinical pharmacists (n = 5). The interpretive description methodology was used to thematically analyze the qualitative data. Estimated daily intake (EDI) and relative infant doses (RID) of AEDs were calculated.
Results: A total of 15 records were included in this systematic review. The included studies reported levels of 8 AEDs in the breastmilk of WWE. Lamotrigine, levetiracetam, carbamazepine, topiramate, valproic acid, and gabapentin did not produce significant adverse effects that warranted discontinuation of breastfeeding. The mean EDI of AEDs ranged from 0.1 to 278.16 µg/g body weight/day and the mean RID ranged from 1.63% to 36.33%. Breastfeeding might be limited or even discontinued when signs of excessive sedation/drowsiness and/or poor weight gain are evident in infants exposed to primidone and phenobarbital, ethosuximide/primidone, or ethosuximide/phenobarbital. The following themes emerged from the qualitative data: 1) diagnosis and care for patients with epilepsy, 2) general issues in caring for patients with epilepsy, and 3) consideration of women’s issues in the pharmacotherapy of epilepsy.
Conclusion: Healthcare providers and WWE might use the findings of this study to make informed decisions on the safety of breastfeeding while taking AEDs. Findings of this qualitative study showed a need to formally adopt uniform guidelines that can guide the diagnosis and care of WWE in the Palestinian healthcare system.
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Keywords
Antiepileptic drugs, Breastfeeding, Epilepsy, Human milk, Lactation, Women