Nieprawidłowości mózgu u niemowląt z przepukliną oponowo-rdzeniową

Background and purpose We evaluated brain abnormalities associated with myelomeningocele in infants. Material and methods Between June 1995 and June 2008, 42 patients with myelomeningocele were treated in our hospital. Only 24 patients (13 males, 11 females, mean age 1.5 months, range 1 day – 11 months) were evaluated by both spinal and brain magnetic resonance imaging (MRI) and were enrolled in the study. Results Brain MRI revealed: hydrocephalus in 21 (87.5%) patients, all of whom required immediate shunting. Total agenesis of the corpus callosum was observed in 2 (8.3%) patients, partial agenesis was seen in 4 (17%) patients and 8 (34%) patients had dysplasia of the corpus callosum. Absence of the septum pellucidum was observed in 2 (8%) patients. Widening of the interhemispheric fissure and colpocephaly were noted in 10 (41%) and in 3 (12%) patients, respectively. Abnormal white matter maturation was observed in 2 (8%) patients. Small posterior fossa was observed in 18 (74%) patients, Chiari malformation in 16 (67%) patients, cerebellar and brain stem hypoplasia in 3 (12%) and 7 (30%) patients, respectively. Conclusions MRI examination of the myelomeningocele site is not sufficient. Clinicians should consider obtaining imaging studies of the entire neuraxis in patients with myelomeningocele.Wstęp i cel pracy W pracy oceniono występowanie nieprawidłowości mózgu u niemowląt z przepukliną oponowo-rdzeniową. Material i metody Od czerwca 1995 r. do czerwca 2008 r. w naszym ośrodku leczono 42 pacjentów. Do badania włączono 24 chorych (13 chłopców i 11 dziewczynek; średni wiek 1,5 miesiąca; zakres wieku: od 1 dnia do 11 miesięcy), u których wykonano badanie mózgu i rdzenia kręgowego za pomocą rezonansu magnetycznego (RM). Wyniki Rezonans magnetyczny mózgu wykazał obecność wodogłowia u 21 pacjentów (87,5%) (wszyscy wymagali niezwłocznego wszczepienia drenażu komorowego). Brak ciała modzelowatego stwierdzono u 2 (8,3%), częściowe nie-wykształcenie ciała modzelowatego u 4 (17%), a dysplazję ciała modzelowatego u 8 pacjentów (34%). Brak przegrody przezroczystej obserwowano u 2 (8%), poszerzenie szczeliny międzypółkulowej u 10 (41%), a kolpocefalię u 3 pacjentów (12%). Nieprawidłowe dojrzewanie istoty białej dotyczyło 2 pacjentów (8%). U 18 osób (74%) stwierdzano małą objętość tylnego dołu czaszkowego, u 16 (67%) malformację Arnolda-Chiariego, a odpowiednio u 3 (12%) i 7 (30%) hipoplazję móżdżku i pnia mózgu. Wnioski Badanie RM samej przepukliny oponowo-rdze-niowej nie jest wystarczające. Klinicyści powinni rozważyć wykonanie badań obrazowych całej osi nerwowej u chorych na przepuklinę oponowo-rdzeniową

Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry

Background: Evidence for the comparative teratogenic risk of antiepileptic drugs is insufficient, particularly in relation to the dosage used. Therefore, we aimed to compare the occurrence of major congenital malformations following prenatal exposure to the eight most commonly used antiepileptic drugs in monotherapy. Methods: We did a longitudinal, prospective cohort study based on the EURAP international registry. We included data from pregnancies in women who were exposed to antiepileptic drug monotherapy at conception, prospectively identified from 42 countries contributing to EURAP. Follow-up data were obtained after each trimester, at birth, and 1 year after birth. The primary objective was to compare the risk of major congenital malformations assessed at 1 year after birth in offspring exposed prenatally to one of eight commonly used antiepileptic drugs (carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, topiramate, and valproate) and, whenever a dose dependency was identified, to compare the risks at different dose ranges. Logistic regression was used to make direct comparisons between treatments after adjustment for potential confounders and prognostic factors. Findings: Between June 20, 1999, and May 20, 2016, 7555 prospective pregnancies met the eligibility criteria. Of those eligible, 7355 pregnancies were exposed to one of the eight antiepileptic drugs for which the prevalence of major congenital malformations was 142 (10\ub73%) of 1381 pregnancies for valproate, 19 (6\ub75%) of 294 for phenobarbital, eight (6\ub74%) of 125 for phenytoin, 107 (5\ub75%) of 1957 for carbamazepine, six (3\ub79%) of 152 for topiramate, ten (3\ub70%) of 333 for oxcarbazepine, 74 (2\ub79%) of 2514 for lamotrigine, and 17 (2\ub78%) of 599 for levetiracetam. The prevalence of major congenital malformations increased with the dose at time of conception for carbamazepine (p=0\ub70140), lamotrigine (p=0\ub70145), phenobarbital (p=0\ub70390), and valproate (p<0\ub70001). After adjustment, multivariable analysis showed that the prevalence of major congenital malformations was significantly higher for all doses of carbamazepine and valproate as well as for phenobarbital at doses of more than 80 mg/day than for lamotrigine at doses of 325 mg/day or less. Valproate at doses of 650 mg/day or less was also associated with increased risk of major congenital malformations compared with levetiracetam at doses of 250\u20134000 mg/day (odds ratio [OR] 2\ub743, 95% CI 1\ub730\u20134\ub755; p=0\ub70069). Carbamazepine at doses of more than 700 mg/day was associated with increased risk of major congenital malformations compared with levetiracetam at doses of 250\u20134000 mg/day (OR 2\ub741, 95% CI 1\ub733\u20134\ub738; p=0\ub70055) and oxcarbazepine at doses of 75\u20134500 mg/day (2\ub737, 1\ub717\u20134\ub780; p=0\ub70169). Interpretation: Different antiepileptic drugs and dosages have different teratogenic risks. Risks of major congenital malformation associated with lamotrigine, levetiracetam, and oxcarbazepine were within the range reported in the literature for offspring unexposed to antiepileptic drugs. These findings facilitate rational selection of these drugs, taking into account comparative risks associated with treatment alternatives. Data for topiramate and phenytoin should be interpreted cautiously because of the small number of exposures in this study. Funding: Bial, Eisai, GlaxoSmithKline, Janssen-Cilag, Novartis, Pfizer, Sanofi-Aventis, UCB, the Netherlands Epilepsy Foundation, and Stockholm County Council