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Neurologic Disease in Women - part 6

Cho con bú, nói chung, khuyến khích đối với phụ nữ có động kinh dùng AED. Những lợi ích của việc nuôi con bằng sữa mẹ được tin là lớn hơn những rủi ro liên quan khi tiếp xúc với trẻ sơ sinh AED (96,98). Ngoại lệ đối với khuyến nghị này được thực hiện khi trẻ xuất hiện hôn mê hoặc cáu kỉnh | 232 NEUROLOGIC DISEASE IN WOMEN Breast-feeding is in general encouraged for women with epilepsy taking AEDs. The benefits of breast-feeding are believed to outweigh the risks associated with further exposure of the neonate to AEDs 96 98 . Exceptions to this recommendation are made when the infant appears lethargic or irritable or if there is feeding difficulty or poor weight gain. Further discussion regarding the concentrations of individual AEDs in breast milk is provided in Chapter 5. Concerns are mounting that exposure to AEDs in utero may confer long-lasting neurodevelopmental or neurocognitive deficits. Fetal head growth retardation and low intelligence 89 99 has been associated with the maternal use of AEDs. Although prospective trials are lacking retrospective studies show that children exposed in utero to valproate in monotherapy or polytherapy are more likely to require special educational resources 100 . Prospective studies are under way to better define the neu-rodevelopmental risks of AED exposure to the developing brain. Recent efforts by the American Academy of Neurology 96 and the American College of Obstetric and Gynecologic Physicians 97 to highlight those issues relevant to the care of women with epilepsy will enhance clinician familiarity with these diverse health concerns. These professional efforts as well as a large-scale professional and public initiative by the Epilepsy Foundation of America provide the medical professional with information and educational resources to enhance the comprehensive care of women with epilepsy. RESOURCES AVAILABLE FOR HEALTH CARE PROVIDERS AND WOMEN WITH EPILEPSY Epilepsy Foundation of America 4351 Garden City Drive Landover MD 20785-2267 Telephone 800-EFA-1000 Web site www.efa.org The Antiepileptic Drug Pregnancy Registry Genetics and Teratology Unit 14CNY-MGH East Room 5022A Charlestown MA 02129-2000 Telephone 888-233-2334 Web site neuro-www2.mgh.harvard.edu aed registry.nclk The American Epilepsy Society 638 .