Abordaje de la epilepsia en el periodo gestacional, una interacción que requiere de medicina basada en evidencia
Approach to epilepsy in the gestational period, an interaction that requires evidence-based medicine
Resumen
Introducción: el manejo de la epilepsia en la paciente embarazada es un tema bastante controvertido por la presencia de los efectos teratogénicos de casi todos los fármacos existentes, igualmente la vía de atención al momento de la culminación de este genera preocupación en los facultativos a cargo de estas pacientes. Objetivo: evaluar la evidencia científica disponible al respecto del abordaje de la epilepsia durante la gestación. Metodología: revisión sistemática en la literatura basada en la evidencia científica disponible a través de estudios multicéntricos y metaanálisis, buscando responder a las interrogantes sobre cuáles son las indicaciones de manejo, ajuste de dosis, vía de atención al culminar el embarazo, efectos teratogénicos entre otras. Se discute el impacto del control de las convulsiones en el embarazo y de la farmacocinética de los fármacos antiepilépticos durante este. Esta información se usa para discutir cómo se puede optimizar el tratamiento durante el embarazo. Conclusiones: el desafío en el manejo de la epilepsia durante el embarazo es equilibrar los riesgos teratogénicos frente a un óptimo control de las crisis comiciales. El asesoramiento previo al embarazo es esencial para garantizar el tratamiento antiepiléptico más adecuado y la administración de dosis mayores de folatos, debe enfatizarse que la gran mayoría de las mujeres con epilepsia tendrán embarazos sin incidentes y darán a luz niños sanos. El objetivo de las recomendaciones de esta revisión es facilitar aún más estos resultados positivos en el embarazo y al culminar el mismo.
ABSTRACT:
Introduction: the management of epilepsy in pregnant patients is a highly controversial issue due to the presence of teratogenic effects of almost all existing pharmacological groups, likewise the care pathway at the time of completion of this generates concern in the physicians in charge of these patients. Objective: to evaluate the scientific evidence available regarding the approach to epilepsy during pregnancy. Methodology: systematic review in the literature based on the scientific evidence available through multicenter studies and meta-analysis, seeking to answer the questions about what are the indications for management, dose adjustment, care pathway at the end of pregnancy, teratogenic effects, among others. The impact of seizure control in pregnancy and the pharmacokinetics of antiepileptic drugs during pregnancy is discussed. This information is used to discuss how treatment during pregnancy can be optimized. Conclusions: The challenge in the management of epilepsy during pregnancy is to balance the fetal and maternal risks associated with seizures against the teratogenic risks. Pre-pregnancy counseling is essential to ensure the most appropriate antiepileptic treatment and that they also receive folate supplementation, it must be emphasized that the vast majority of women with epilepsy will have uneventful pregnancies and give birth to healthy children. The aim of the recommendations in this review is to further facilitate these positive outcomes in and after pregnancy.
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Referencias
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