The risk of major congenital malformations is influenced not only by type of antiepileptic drug, but also by dose and other variables, which should be taken into account in the management of epilepsy in women of childbearing potential.
- Details
- ICNA
- News
- Hits: 1918
The risk of major congenital malformations is influenced not only by type of antiepileptic drug, but also by dose and other variables, which should be taken into account in the management of epilepsy in women of childbearing potential.
Use of four of the most commonly prescribed seizure-control drugs at the beginning of pregnancy is associated with a dose-dependent increased risk of major birth defects. The findings, from 33 countries worldwide published Online First in The Lancet Neurology, are the first to provide a multivariable analysis of the risks associated with individual drugs and their doses, and will be crucial in helping doctors identify the safest effective treatment for women with epilepsy considering pregnancy.
Between 0.3% and 0.7% of all pregnancies are in women with epilepsy. Most of these women need to use antiepileptic drugs during pregnancy because uncontrolled seizures can harm the mother and fetus. However, previous research suggests that epilepsy drugs (particularly valproic acid) can increase the risk of birth defects. But until now, no adequately powered studies have compared the risks associated with different doses or assessed the influence of potential confounders (other factors that can affect outcomes) such as a family history of birth defects or severity of epilepsy.
"Present guidelines caution on the use of valproic acid during pregnancy, but offer little guidance on alternative options and how to manage women whose seizures cannot be controlled by other drugs", explains Torbjörn Tomson from the Karolinska Institute, Stockholm, Sweden and international colleagues. To provide more evidence, the researchers investigated the association between the use of carbamazepine, lamotrigine, valproic acid (valproate), and phenobarbital at different doses and the risk of major birth defects detected up to the end of the first year after birth.
The study used data from the International Registry of Antiepileptic Drugs and Pregnancy (EURAP) and included 3909 pregnancies. A total of 230 pregnancies associated with major birth defects were identified by the end of the first year after birth. An increase in the rate of birth defects was noted with increasing dose for all drugs. The rate was lowest for low doses of the drugs lamotrigine (less than 300 mg per day) and carbamazepine (less than 400 mg per day).
The highest doses of valproic acid (1500 mg per day or greater) and phenobarbital (150 mg per day or day or greater) posed the highest risk to the fetus, with particularly high rates of birth defects recorded in pregnancies exposed to valproic acid 1500 mg per day or greater. The authors caution: "It should be emphasised, however, that, irrespective of which of the four investigated drugs was prescribed, the vast majority of women gave birth to perfectly healthy children."*
Additionally, the risk of defects was four times greater for offspring with a parental history of major congenital malformations. The authors say: "Our results show that dose selection is as crucial as the choice of drug...[and] gives the prescriber the possibility of assessing how teratogenic [ability to cause birth defects] risks at that dose compare with the risk associated with alternative treatments at various doses." In a Comment, W Allen Hauser from Columbia University, New York, USA says: "The findings are important to the clinician treating people with epilepsy because they provide specific information not only on the drug but also on the dose.
It is easy to recommend against use of a specific drug (valproic acid, for instance) because of a higher risk of malformations, but if seizure control is not possible with alternative therapeutic regimens, such recommendations are difficult to implement. The data provide another reason for use of the lowest dose of a drug associated with optimum seizure control. Incidence of major congenital malformations associated with a low dose of a higher-risk drug might be lower than that associated with a high dose of a lower-risk drug."
Read More
- Details
- ICNA
- News
- Hits: 492
Progress in paediatric neurosciences is proceeding rapidly, and we are entering an era in which technologies will allow for a greater knowledge and understanding of normal and abnormal brain development. Because of our improved diagnostic abilities, it is now possible to identify even subtle brain abnormalities early on, thus allowing for early intervention. However, in certain areas of the world, many children do not benefit from this progress because of the shortage of child neurologists and adequately equipped medical centers.
In recent years, this progress in diagnostic and therapeutic capabilities and the growing necessity for advanced technology to diagnose CNS disorders have greatly increased the divide between developed and developing countries. In addition, child neurologists from developing countries are hampered by the lack of professional networks that could provide continuous education and updates on new developments in the specialty.
About 70% of children with disablities live in resource-poor countries, and most of them have neurological diseases. Protein-energy malnutrition, dietary micronutrient deficiencies, environmental toxins and a lack of early sensory stimulation may contribute to the high prevalence of neurodevelopmental disabilities in these countries. Access to up-to-date imaging and genetic and biochemical testing is limited in some regions, which is particularly problematic because delaying diagnosis and treatennt can have deleterious effects on a child's development.
There is an urgent need to identify regional centers and reference labd to improve diagnosis of neurological disease in children in developing countries. In Central Asia, the number of qualified child neurologists has increased in recent years, but they are not equally distributed between urban and rural areas, with about 95% of them concentrated in the countries' capital cities. The situation is worse in Africa, where many countries have no child neurologists at all.
Education is one of the primary goals and purposes of the International Child Neurology Association (ICNA). The ICNA Education Committee has organized numerous programs for improving participants' knowledge of paediatric neurological disorders at the primary care level and for promoting clinical research interest in child neurology and have been organized in several countries, including Egypt, Estonia, Guatemala, India, Kazakhstan, Kenya, Peru, Ukraine, and Uruguay. The main goals of these events were to improve the use of relevant diagnostic measures and management in paediatric neurological care, and enrich the teaching and academic skills of local trainers.
Under the ICNA educational programmes, a number of different strategies have been adopted to promote education in emerging countries. Among these was for the ICNA executive board to hold it's annual meeting in conjunction with local or regional child neurology organizations, and for the association to provide speakers and scientific support to local conferences. In doing these things, ICNA has had a significant impact on the development of regional child neurology associations in Asia, Africa, Eastern Europe, the Middle East, and South America.
In 2002, my administration established research as the top prerogative of our society. Not surprisingly, ICNA's primary research priority is to document and define the causes of neurological handicaps in children in various geographic regions so that approaches to prevention and treatment can be tailored to a region's specific needs.
We urgently need to build this research capacity in emerging countries through international cooperation so that we are united against the devastating neurological disorders that affect millions of children worldwide. ICNA has a unique role in improving international cooperation and promoting clinical and scientific research byneproviding a medium through which physician can exchange opinions at an international level for the advancement of paediatric neurosciences.
The Internet is the key to coordinating global education in paediatric neurology. ICNA supports a Web site, www.icnapedia.org, that provides access to pertinent papers, clinical guidelines, consensus statements,and management protocols. The association is deeply committed to providing innovative, educational and training programs for all professional involved in the care of children with neurological disorders. Its International Education committee plans to develop a distance learning course in paediatric neurology for those who are not able to travel to attend courses and conferences in person.
ICNA is uniquely qualified and well positioned to remedy this deficit by reducing the gap and increasing the level of child neurology care all around the world. To accomplish this ambitions goal, ICNA should work with the World Federation of Neurology and World Health Organization. This international cooperation is more important than ever to promote brain health globally.
Part of this article is adapted from a paper by Prof Curatolo which appeared in the Journal of Child Neurology (2010;25:1444-9)
- Details
- Dr Paolo Curatolo
- News
- Hits: 584
The abstract submission deadline for Autism Spectrum Disorders: From Mechanisms to Therapies is July 29, 2011. We encourage you to submit your research for presentation and hope you will join us, our co-organizers, and leading researchers in Arlington, USA from November 9-11, 2011.
The abstract submission deadline for Autism Spectrum Disorders: From Mechanisms to Therapies is July 29, 2011. We encourage you to submit your research for presentation and hope you will join us, our co-organizers, and leading researchers in Arlington, USA from November 9-11, 2011.
An official 2011 SFN satellite meeting, Autism Spectrum Disorders: From Mechanisms to Therapies, will focus on recent advances in understanding the neural basis of autism spectrum disorders (ASD).
The aim of this meeting is to bring together key researchers working on autism spectrum disorders at multiple levels, with a specific goal of considering how current basic research findings and candidate mechanisms can be directed towards therapies and treatments.
The topics that will be discussed include:
- Autism Genetics
- From Animal Models to Mechanisms
- Synaptic Mechanisms
- Circuit Mechanisms
- Cognitive Mechanisms
- From Models to Potential Therapeutics
Abstracts are now being accepted on the above topics.Abstract Submission Deadline: July 29, 2011
Read More
- Details
- ICNA
- News
- Hits: 494
It is my distinct honor, on behalf of the International Child Neurology Association, to invite you to register for the 12th International Child Neurology Congress to be held in Brisbane, Australia during May 2012.
The Congress will be held jointly with the 11th Asian and Oceanian Congress of Child Neurology, and promises to attract a large international audience. As in the past congresses, the Scientific Program will be of the highest caliber, emphasizing not only the latest developments and advances in child neurology, but also a review of current standard of care in the practice of child neurology. Participants from all over the world will be able to engage in collegial exchange of ideas in a friendly and warm atmosphere.
An attractive socio-cultural program is also being planned, and participants and their families will be able to enjoy both the diversity and uniqueness that Australia has to offer. Therefore, it is with great enthusiasm that we urge you to join us in Brisbane, May 2012 in what we anticipate to be a memorable scientific, academic and social experience.
Harry T. Chugani, M.D.
President, The International Child Neurology Association (ICNA)
Bruce and Rosalie Rosen Professor of Pediatrics and Neurology
Director, Positron Emission Tomography Center
Children's Hospital of Michigan, Detroit Medical Center
Wayne State University School of Medicine, Detroit, Michigan, USA
Read More
- Details
- Harry Chugani
- News
- Hits: 442