MONITORAGE DES MEDICAMENTS ANTIEPILEPTIQUES PENDANT LA GROSSESSE. SIGNIFICATION CLINIQUE DES MODIFICATIONS DES NIVEAUX PLASMATIQUES DES MEDICAMENTS ANTIEPILEPTIQUES. EXPERIENCES CLINIQUES CHEZ 30 MALADES

A prospective study was made of 30 epileptic women from the beginning of their pregnancy until childbirth; 23 of the patients were suffering from partial epilepsy, 7 from generalized epilepsy. Eleven were undergoing treatment with barbiturates alone; 6 with phenytoin alone, 2 with clonazepam alone; 2 patients were undergoing no treatment; the others were under treatment associating 2 (in one case 3) anti-epileptic drugs. The study involved monthly monitoring of the neurological and obstetric data and the plasma concentrations of the anti-epileptic drugs. In comparison with the 9 months preceding the pregnancy, 7 patients observed an increase in the number of attacks during pregnancy; for 8 of them the frequency diminished and for 15 there was no change. For most of the patients, apparent plasma clearance of phenobarbitone and phenytoin increased considerably. Average plasma clearance of phenobarbitone increased significantly from the 25th to the 32nd week and from the 33rd to the 41st week in comparison with the first weeks (1 to 24). Average plasma clearance of phenytoin increased significantly only from the 33rd to the 41st week. During the last months of pregnancy (33rd to 41st week) the plasma levels of the drugs were within the therapeutic values for 3 of the 7 patients who experienced an increase in the number of attacks, in 10 of the 15 patients who experienced no modification in the frequency of attacks and in 5 out of the 8 patients who experienced an improvement. Taking into consideration the modifications in plasma levels during pregnancy, a fall was observed in the levels of the 'therapeutic range' to sub-therapeutic levels in 3 of the patients whose condition worsened, in one patient whose condition remained unchanged and in one patient whose condition improved. The correlation between plasma levels and the frequency of attacks was illustrated in some representative cases.