Epilepsili Kadınlarda Gebelik
Özet
Epilepsi, kortikal nöronlardaki anormal elektriksel deşarjlar sonucu tekrarlayan nöbetlerle karakterize, psikososyal sorunlara ve yaşam kalitesinde düşüşe yol açan kronik nörolojik bir hastalıktır. Dünya genelinde 65 milyondan fazla bireyi etkileyen bu hastalığın patogenezinde uyarıcı ve inhibe edici nörotransmitterler arasındaki denge bozukluğu ile iyon kanalı anormallikleri rol oynar. Tanısında detaylı hasta öyküsü, EEG ve MR gibi görüntüleme yöntemleri kullanılırken; tedavisinde ilaç, cerrahi, nörostimülasyon ve psikolojik destek yöntemlerine başvurulmaktadır. Gebelik dönemi ise kadında önemli fizyolojik ve hormonal değişimleri beraberinde getirir. Epilepsili gebe kadınlar yüksek risk kategorisinde değerlendirilmekte olup, migrenden sonra gebelikte en sık rastlanan ikinci nöloji hastalıktır. Bu süreçte nöbetlerin varlığı ve antiepileptik ilaç (AEİ) kullanımı; düşük tehdidi, prematüre eylem, gelişim geriliği ve konjenital malformasyonlar gibi hem maternal hem de fetal riskleri artırır. İlaç tedavisinde temel prensip, nöbet kontrolünü sağlarken teratojenite riskini en aza indirecek en düşük dozda monoterapi tercihidir. Doğum eylemi ve doğum sonrası (postpartum) dönemde uyku yoksunluğu ve anksiyete gibi faktörler nedeniyle nöbet riski yükseldiğinden, multidisipliner bir yaklaşım, yakın takip, intravenöz erişim, ilaç uyumu ve sosyal destek kritik önem taşır.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures resulting from abnormal electrical discharges in cortical neurons, leading to psychosocial challenges and a reduced quality of life. Affecting over 65 million individuals worldwide, its pathogenesis involves an imbalance between excitatory and inhibitory neurotransmitters as well as ion channel abnormalities, with diagnosis relying on detailed history, EEG, and neuroimaging, while management includes medication, surgery, neurostimulation, and psychological support. Pregnancy introduces significant physiological and hormonal alterations, and pregnant women with epilepsy are categorized as high-risk, making it the second most common neurological condition during gestation after migraine. During this period, both active seizures and the use of anti-epileptic drugs (AEDs) increase maternal and fetal risks, including miscarriage threats, preterm labor, fetal growth restriction, and congenital malformations. The core principle of pharmacological treatment is utilizing monotherapy at the lowest effective dose to control seizures while minimizing teratogenic risks, particularly avoiding high-dose valproic acid unless essential. Because the intrapartum and postpartum periods carry an elevated risk of seizure recurrence due to sleep deprivation and anxiety, a multidisciplinary approach encompassing close monitoring, intravenous access, strict medication adherence, and robust social support is crucial to optimizing maternal and neonatal outcomes.
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