Опыт применения прогестерона во время беременности у женщин с эпилепсией
Опыт применения прогестерона во время беременности у женщин с эпилепсией
Цаллагова Е.В., Генералов В.О., Полянчикова О.Л., Садыков Т.Р. Опыт применения прогестерона во время беременности у женщин с эпилепсией. Гинекология. 2017; 19 (5): 40–43. DOI: 10.26442/2079-5696_19.5.40-43
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Tsallagova E.V., Generalov V.O., Polyanchikova O.L., Sadykov T.R. The experience of using progesterone during pregnancy in women with epilepsy. Gynecology. 2017; 19 (5): 40–43. DOI: 10.26442/2079-5696_19.5.40-43
Опыт применения прогестерона во время беременности у женщин с эпилепсией
Цаллагова Е.В., Генералов В.О., Полянчикова О.Л., Садыков Т.Р. Опыт применения прогестерона во время беременности у женщин с эпилепсией. Гинекология. 2017; 19 (5): 40–43. DOI: 10.26442/2079-5696_19.5.40-43
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Tsallagova E.V., Generalov V.O., Polyanchikova O.L., Sadykov T.R. The experience of using progesterone during pregnancy in women with epilepsy. Gynecology. 2017; 19 (5): 40–43. DOI: 10.26442/2079-5696_19.5.40-43
В статье рассматривается зависимость течения эпилепсии от концентрации прогестерона в сыворотке крови во время беременности. Описывается история болезни и ведения беременности пациентки 36 лет с симптоматической фокальной затылочной эпилепсией на фоне новообразования головного мозга. На 11-й неделе беременности у нее было обнаружено снижение уровня прогестерона до 21,7 нмоль/л при концентрации леветирацетама 31,2 мкг/мл. Добавление в терапию препарата прогестерона 600 мг/сут позволило постепенно повысить концентрацию прогестерона до достаточного уровня 440 нмоль/л, что сопровождалось повышением концентрации леветирацетама в крови до 49,8 мкг/мл без увеличения дозы противосудорожного препарата. В качестве практического вывода рекомендуется использование во время беременности коррекции уровня прогестерона в крови с целью профилактики рецидива эпилептических приступов. Ключевые слова: прогестерон, беременность, эпилепсия, приступы.
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The article examines the dependence of the course of epilepsy on the concentration of progesterone in the blood serum during pregnancy. A case history of 36-year-old patient with symptomatic focal occipital epilepsy on the background of neoplasm of the brain is described. At 11 weeks of pregnancy, she was found to have a decrease in the level of progesterone to 21.7 nmol/l at a concentration of levetiracetam 31.2 μg/ml. The addition of progesterone to the therapy of 600 mg/day allowed to gradually increase the concentration of progesterone to a sufficient level of 440 nmol/l, which was accompanied by an increase in the concentration of levetiracetam in the blood to 49.8 μg/ml without increasing the dose of the anticonvulsant drug. As a practical conclusion, it is recommended to use during pregnancy correction of the level of progesterone in the blood as a measure to prevent the recurrence of epileptic seizures. Key words: progesterone, pregnancy, epilepsy, seizures.
1. Bardy AH. Incidence of seizures during pregnancy, labor and puerperium in epileptic women: a prospective study. Acta Neurol Scand 1987; 75 (5): 356–60.
2. Tanganelli P, Regesta G. Epilepsy, pregnancy, and major birth anomalies: an Italian prospective, controlled study. Neurology 1992; 42 (4): 89–93.
3. Foldvary-Schaefer N. Hormones and seizures. Cleve Clin J Med 2004; 71 (2): 11–8.
4. Morrell MJ, Sperling MR, Stecker M et al. Sexual dysfunction in partial epilepsy: a deficit in physiologic sexual arousal. Neurology 1994; 44: 243–7.
5. Hussain Z, Hasan KZ, Aziz H et al. Clinical and neurological study of women with precatamenial epilepsy. J Coll Physicians Surg Pak 2007; 17 (4): 211–4.
6. Herzog AG, Fowler KM, Sperling MR. Distribution of seizures across the menstrual cycle in women with epilepsy. Epilepsia 2015; 56 (5): 58–62.
7. Rosciszewska D. Analysis of seizure dispersion during menstrual cycle in women with epilepsy. Monogr Neural Sci 1980; 5: 280–4.
8. Belelli D, Lambert JJ. Neurosteroids: endogenous regulators of the GABA (A) receptor. Nat Rev Neurosci 2005; 6: 565–75.
9. Reddy DS, Gould J, Gangisetty O. A mouse kindling model of perimenstrual catamenial epilepsy. J Pharmacol Exp Ther 2012; 341 (3): 784–93.
10. Taubøll E, Sveberg L, Svalheim S. Interactions between hormones and epilepsy. Seizure 2015; 28: 3–11.
11. Herzog AG, Blum AS, Farina EL et al. Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use. Neurology 2009; 72 (10): 911–4.
12. Reddy DS. Pharmacology of catamenial epilepsy. Methods Find Exp Clin Pharmacol 2004; 26 (7): 547–61.
13. Grunewald RA, Aliberti V, Panayiotopoulos CP. Exacerbation of typical absence seizures by progesterone. Seizure 1992; 1 (2): 137–8.
14. Yust-Katz S, de Groot JF, Liu D. Pregnancy and glial brain tumors. Neuro Oncol 2014; 16 (9): 1289–94.
15. Glauser T, Ben-Menachem E, Bourgeois B. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2013; 54 (3): 551–63.
16. Tomson T, Palm R, Källén K. Pharmacokinetics of levetiracetam during pregnancy, delivery, in the neonatal period, and lactation. Epilepsia 2007; 48 (6): 1111–6.
________________________________________________
1. Bardy AH. Incidence of seizures during pregnancy, labor and puerperium in epileptic women: a prospective study. Acta Neurol Scand 1987; 75 (5): 356–60.
2. Tanganelli P, Regesta G. Epilepsy, pregnancy, and major birth anomalies: an Italian prospective, controlled study. Neurology 1992; 42 (4): 89–93.
3. Foldvary-Schaefer N. Hormones and seizures. Cleve Clin J Med 2004; 71 (2): 11–8.
4. Morrell MJ, Sperling MR, Stecker M et al. Sexual dysfunction in partial epilepsy: a deficit in physiologic sexual arousal. Neurology 1994; 44: 243–7.
5. Hussain Z, Hasan KZ, Aziz H et al. Clinical and neurological study of women with precatamenial epilepsy. J Coll Physicians Surg Pak 2007; 17 (4): 211–4.
6. Herzog AG, Fowler KM, Sperling MR. Distribution of seizures across the menstrual cycle in women with epilepsy. Epilepsia 2015; 56 (5): 58–62.
7. Rosciszewska D. Analysis of seizure dispersion during menstrual cycle in women with epilepsy. Monogr Neural Sci 1980; 5: 280–4.
8. Belelli D, Lambert JJ. Neurosteroids: endogenous regulators of the GABA (A) receptor. Nat Rev Neurosci 2005; 6: 565–75.
9. Reddy DS, Gould J, Gangisetty O. A mouse kindling model of perimenstrual catamenial epilepsy. J Pharmacol Exp Ther 2012; 341 (3): 784–93.
10. Taubøll E, Sveberg L, Svalheim S. Interactions between hormones and epilepsy. Seizure 2015; 28: 3–11.
11. Herzog AG, Blum AS, Farina EL et al. Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use. Neurology 2009; 72 (10): 911–4.
12. Reddy DS. Pharmacology of catamenial epilepsy. Methods Find Exp Clin Pharmacol 2004; 26 (7): 547–61.
13. Grunewald RA, Aliberti V, Panayiotopoulos CP. Exacerbation of typical absence seizures by progesterone. Seizure 1992; 1 (2): 137–8.
14. Yust-Katz S, de Groot JF, Liu D. Pregnancy and glial brain tumors. Neuro Oncol 2014; 16 (9): 1289–94.
15. Glauser T, Ben-Menachem E, Bourgeois B. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2013; 54 (3): 551–63.
16. Tomson T, Palm R, Källén K. Pharmacokinetics of levetiracetam during pregnancy, delivery, in the neonatal period, and lactation. Epilepsia 2007; 48 (6): 1111–6.
1. ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова» Минздрава России. 117997, Россия, Москва, ул. Академика Опарина, д. 4;
2. ГБУЗ «Городская клиническая больница №15 им. О.М.Филатова» Департамента здравоохранения г. Москвы. 111539, Россия, Москва, ул. Вешняковская, д. 23;
3. Центр диагностики и лечения эпилепсии ООО «Центр внедрения передовых медицинских технологий "ПланетаМед"». 117105, Россия, Москва, Варшавское ш., д. 13
*gogayeva@mail.ru
1. V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4;
2. O.M.Filatov City Clinical Hospital №15 of the Department of Health of Moscow. 111539, Russian Federation, Moscow, ul. Veshniakovskaia, d. 23;
3. Center of Diagnostics and Treatment for Epilepsy “PlanetaMed”. 117105, Russian Federation, Moscow, Varshavskoe sh., d. 13
*gogayeva@mail.ru