Combination Therapy Of Valproic Acid And Levetiracetam During

CASE REPORT / OLGU SUNUMU
2013
Combination Therapy Of Valproic Acid And Levetiracetam During
Pregnancy And A Lucky Baby: A Case Report
Gebelik Sırasında Valproik Asit ve Levetirasetam Kombinasyon Tedavisi ve Şanslı Bir
Bebek: Olgu Sunumu
AUTHORS /
YAZARLAR
Davut Baltaci
Department of Family
Medicine, Duzce
University Medical
Faculty, Duzce
Ahmet Karatas
Department of Obstetrics
and Gynecology, Duzce
University Medical
Faculty, Duzce
Recep Eroz
Department of Medical
Genetic, Duzce
University Medical
Faculty, Duzce
ABSTRACT
Antiepileptic agents use during pregnancy create a challenge for health care
professionals. The ideal management of pregnant women with epilepsy requires good
achieving. Here, we presented a case of pregnant female with epilepsy on combination
therapy with levetiracetam and valproic acid. The case documents positive outcome in a
pregnant woman with epilepsy taking levetiracetam and valproic acid during pregnancy.
Keywords: Epilepsy, pregnancy, levetiracetam
ÖZET
Gebelik sırasında antiepileptik ajanların kullanımı sağlık profesyonelleri için özel
bir durum oluşturur. Gebe kadınların epilepsi yönetimi başarılı şekilde yapılmalıdır. Bu
yazıda levetirasetam ve valproik asit kombinasyon tedavisi altında olan epileptik bir
gebe kadın olguyu sunuyoruz. Olgu gebelik sırasında levetirasetam ve valproikasit
kullanan kadında elde edilen pozitif sonuçları belgelemektedir.
Anahtar Kelimeler: Epilepsi, gebelik, levetirasetam
Aylin Yilmaz
Department of Family
Medicine, Duzce
University Medical
Faculty, Duzce
Ahmet Celer
Department of Family
Medicine, Duzce
University Medical
Faculty, Duzce
Serkan Karacam
Department of Family
Medicine, Duzce
University Medical
Faculty, Duzce
Harun Deler
Department of Family
Medicine, Duzce
University Medical
Faculty, Duzce
Ismail Hamdi Kara
Department of Family
Medicine, Duzce
University Medical
Faculty, Duzce
92 Introduction
The ideal management of women with epilepsy during pregnancy and the
postpartum period involves achieving an optimal balance between minimizing fetal
and neonatal exposure to the deleterious influences. Women with increased seizures
during pregnancy tend to have sub-therapeutic antiepileptic drugs (AEDs)
concentrations (1, 2). More than 90% of all women with epilepsy who take AEDs will
undergo normal pregnancies and give birth to children free of birth defects, though
mothers on AEDs have two to three times higher incidence of malformations (3).
Valproate and carbamazepine have been associated with neural tube defects and
phenytoin with cleft lip/palate and heart and urogenital defects. The safety and
efficacy of novel anticonvulsants during pregnancy in women with epilepsy are not
well established. It is not known whether the levetiracetam (LEV) can be used safely
in human pregnancy (3-5). Prenatal exposure to levetiracetam has been shown to
cause skeletal abnormalities and growth retardation in animal studies, but the
teratogenicity of this new antiepileptic drug in humans is still unknown (6). Here, we
presented a case of a pregnant woman with epilepsy, who has used combination
therapy of two anti-epileptic drugs, and an offspring during first year of age after
birth.
Case
A female baby was delivered with cesarean section due to foot presentation at
term. The baby was alive, but was 2670 gram in weight. Apgar scores were 4 at first
minute and 6 at 5th minute (Table 1). The baby was interned to newborn intensive
Euras J Fam Med 2013; 2(2):92-94
care unit, and discharged with 3050 gram in weight
and 49 cm in length. The parents were
non-consanguineous and young. The mother was
thirty years-old and suffered from epilepsy since
fifteen years-old under treatment of 2000 mg/day
valproic acid and 1000 mg/day levetiracetam. She
was at the 6th week of gestation, when admitted to
health center. Treatment was regulated as valproic
acid 1000 mg/ day, and levetiracetam dose was kept
on the same throughout gestational period, with good
control of her seizure disorder. The pregnancy was
first and uneventful. The mother has used 0.4 mg
folic acid whenever she was realized as pregnant.
Regular obstetric ultra- sonographic examination was
observed normal, except growth retardation.
Screening tests at 12th and 17th weeks of gestation
were normal.
family physicians, involved in their care. The above
case document positive outcome in a pregnant female
with epilepsy taking levetiracetam and valproic acid
during pregnancy. She was completely seizure-free
on combination therapy. Because of the retrospective
nature and small number of combination therapy with
levetiracetam and valproic acid, caution should be
taken when interpreting the above outcome. This case
may be encouraging for those seeking preliminary
data on the use of levetiracetam and valproic acid
combination therapy during pregnancy.
Table 1. Basic features of the baby at birth
Information at birth
Week of confinement (week)
40
Apgar score
4 (1.min) - 6 (5.min)
Weight (g)
2670 (25-50 percentile)
Length (cm)
Head circumference (cm)
48 (25-50 percentile)
34 (25 percentile)
After discharge, the baby has been monthly
monitored by her family physician in primary care for
her growth pattern for one year. Breastfeeding was
not offered, because the mother had to keep on her
own anti-epileptic treatment. Growth pattern of the
baby was demonstrated in Figure 1. Postnatal growth
was observed as normal, but weight gain delayed.
Neurological and motor developments were normal.
At sixth month, abdominal ultrasonographic
examination and brain computed tomography
revealed normal signs.
Discussion
The risk of congenital abnormalities is
approximately three times higher in fetus exposed to
anti-epileptic agents compared to normal population
(7,8). Pregnant women with epilepsy create a
challenge for health care professionals, especially
Figure 1. Demonstration of growth pattern (weight and
height) of the baby for first year of age
Conclusion
The child exposed to levetiracetam and valproic
acid may be not at an increased risk of congenital
anomaly. Combination therapy with levetiracetam
and valproic acid may therefore be a preferable drug
choice, where appropriate.
93
Baltacı D et al. Combination Therapy Of Valproic Acid And Levetiracetam During Pregnancy And A Lucky Baby: A Case Report
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Corresponding Author / İletişim için
Assoc. Prof. Dr. Davut Baltaci
Department of Family Medicine,
Duzce University Medical Faculty,
Duzce, Turkey
E-mail: [email protected]
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