​Houston – In a prospective study antiepilepsy drugs levels in women, reviewed by Dan Hurley of Neurology Today, being presented at the AES meeting on December 4th 2016, researchers found blood levels of antiepilepsy drugs in their breastfed infants to be either undetectable or well below the therapeutic range.”What we’ve been able to show is that while some drug does get into the baby, it’s very little compared to what’s in the mother,” said the first author of the study, Angela Birnbaum, PhD, professor of experimental and clinical pharmacology at the University of Minnesota College of Pharmacy. Lead study author Andrew G. Herzog, MD, FAAN, director of the Harvard Neuroendocrine Unit at Beth Israel Deaconess Medical Center in Boston and professor of neurology at Harvard Medical School, said the findings “offer reassurance to women who would like to breastfeed their babies.” A total of 351 pregnant women with epilepsy were enrolled up to 20 weeks’ gestational age and were followed until nine months postpartum; results were available on 121 breastfeeding infants.

Drug measurements were below the lower limits of testing in six of 64 infants whose mothers were taking lamotrigine, 40 of 54 taking levetiracetam, all nine taking carbamazepine, and all seven taking oxcarbazepine.”Our findings may explain why prior studies have found no adverse neurodevelopment effects of breastfeeding infants while taking an antiepilepsy drugs,” the researchers concluded.

Michael R. Sperling, MD, FAAN, professor of neurology and director of the Jefferson Comprehensive Epilepsy Center at Thomas Jefferson University in Philadelphia, said the study provides “important and useful information. It’s very reassuring.” Even so, he said, “This should not be taken as a guarantee that the drugs have no effects on breastfed infants. Some of the babies in this study had detectable drug levels. If a baby is lethargic or sleepier than babies are expected to be, that could raise a concern, which might be addressed by testing of a drug level.

“Practice has changed,” she said. “Valproic acid, at least in this group, is being avoided. That’s probably not the case around the world. The participating centers in our study are sophisticated. We (Dr Paulo Bittencourt, Dimpna in Curitiba, Brasil) add that obviously none of the patients is taking any of the antiepilepsy drugs most commonly used in Brasil or Latin America, like clobazam, phenobarbitone, phenytoin, carbamazepine, In fact, each pregnancy needs to be evaluated individually by the physician.

text adapted from Neurology Today by Prof. Dr. Paulo Bittencourt, PhD, FAAN

AES Abstract 1.290: Birnbaum A, Meador K, Bathena SP, et al. Antiepileptic drug exposure in infants of breastfeeding mothers with epilepsy

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