{"id":6474,"date":"2020-05-14T09:52:31","date_gmt":"2020-05-14T08:52:31","guid":{"rendered":"https:\/\/euromedic.rs\/pregledi\/neurologija-racionalno-lecenje-epilepsije-copy\/"},"modified":"2020-10-07T10:47:17","modified_gmt":"2020-10-07T09:47:17","slug":"neurologija-epilepsija-i-trudnoca","status":"publish","type":"post","link":"https:\/\/euromedic.rs\/pregledi\/specijalisticki-pregledi\/neurologija\/neurologija-epilepsija-i-trudnoca\/","title":{"rendered":"Neurologija &#8211; Epilepsija i trudno\u0107a"},"content":{"rendered":"<p>Jedan od najva\u017enijih aspekata le\u010denja epilepsije predstavlja primena antiepilepti\u010dkih lekova kod \u017eena u reproduktivnom periodu. Populacione studije su pokazale da oko 25% pacijenata sa epilepsijom predstavljaju \u017eene u generativnom periodu, a da je u\u010destalost epilepsije kod trudnica 0,2-0,4%.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Primena antiepilepti\u010dkih lekova (AEL) kod svih trudnica sa epilepsijom je nu\u017ena i neophodna jer eventualna pojava velikih epilepti\u010dkih napada u trudno\u0107i pove\u0107ava rizik od ozbiljnih komplikacija (toksemija, placentalno krvavljenje, prevremeni poro\u0111aj), pa \u010dak i perinatalne smrti deteta i\/ili trudnice. S druge strane AEL<span class=\"Apple-converted-space\">\u00a0 <\/span>pove\u0107avaju rizik da se novoro\u0111en\u010de rodi sa malformacijama, anomalijama i\/ili da se kasnije usporeno razvija. Pri primeni jednog leka za le\u010denje epilepsije, u\u010destalost malformacija je 4-8% \u0161to je dvostruko vi\u0161e nego u op\u0161toj populaciji trudnica (2-4%). Vrednosti rastu sa pove\u0107avanjem broja i doze antiepileptika.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Primena AEL kod \u017eena sa epilepsijom u trudno\u0107i zahteva dobro odmeren balans izme\u0111u pune kontrole napada i minimiziranja \u0161tetnog uticaja lekova na plod. Zbog toga je neophodno kod svih mladih \u017eena sa epilepsijom koje ne koriste kontracepciju, sprovoditi mere primarne prevencije. Ove mere imaju smisla jedino ukoliko se primenjuju pre za\u010de\u0107a. S obzirom na to da se mnoge malformacije javaljaju izme\u0111u 4. i 8. nedelje trudno\u0107e, tj. u vreme kada ve\u0107ina \u017eena i ne zna sa sigurno\u0161\u0107u da li je trudna. Ve\u0107 na samom po\u010detku le\u010denja treba optimizovati antiepilepti\u010dku terapiju tako da se kontrola napada uspostavi sa jednim (ili najvi\u0161e dva leka) koji imaju mali teratogeni potencijal (\u0161tetno dejstvo na plod), a to su pre svih lamotrigin, levetiracetam i karbamazepin. S obzirom na to da je nedostatak folata odgovoran za razvoj nekih malformacija, jo\u0161 pre za\u010de\u0107a treba zapo\u010deti sa uzimanjem folne kiseline u dozi izme\u0111u 0,4 i 4 mg dnevno. Na kraju, \u017eenu treba ohrabriti da zatrudni i svaku narednu posetu iskoristiti za savetovanje.<\/p>\n<p>Kada \u017eena sa epilepsijom zatrudni sprovode se mere sekundarne prevencije u vidu ehosonografskog pra\u0107enja trudno\u0107e. Izme\u0111u 16. i 18. nedelje trudno\u0107e kvalitetno izveden ultrazvu\u010dni pregled (&#8220;anatomski ultrazvuk&#8221;) mo\u017ee da prika\u017ee sve va\u017ene strukture fetusa. U kombinaciji sa normalnim nivoom alfa-feto proteina u serumu majke normalan anatomski ultrazvuk isklju\u010duje postojanje malformacija sa verovatno\u0107om od 95%.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>U Euromedik ustanovama postoji mogu\u0107nost da se \u017eene sa epilepsijom koje planiraju trudno\u0107u ili trudnice sa epilepsijom pregledaju od strane epileptologa (<a href=\"https:\/\/euromedic.rs\/usluga\/specijalisticki-pregled-neurologa\/\">neurolog<\/a> sa dodatnom edukacijom iz oblasti epilepsija) koji \u0107e prepisati najoptimalniju terapiju i koji je najpozvaniji da daje odgovaraju\u0107e savete u vezi sa epilepsijom i trudno\u0107om.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Jedan od najva\u017enijih aspekata le\u010denja epilepsije predstavlja primena antiepilepti\u010dkih lekova kod \u017eena u reproduktivnom periodu&#8230;.<\/p>\n","protected":false},"author":1,"featured_media":6476,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[484],"tags":[414,295,135],"class_list":["post-6474","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-neurologija","tag-epilepsija","tag-neurologija","tag-trudnoca"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Neurologija - Epilepsija i trudno\u0107a- DIjagnostika i le\u010denje<\/title>\n<meta name=\"description\" content=\"Jedan od najva\u017enijih aspekata le\u010denja epilepsije predstavlja primena antiepilepti\u010dkih lekova kod \u017eena u reproduktivnom periodu. Populacione studije su...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/euromedic.rs\/pregledi\/specijalisticki-pregledi\/neurologija\/neurologija-epilepsija-i-trudnoca\/\" \/>\n<meta property=\"og:locale\" content=\"sr_RS\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Neurologija - Epilepsija i trudno\u0107a- DIjagnostika i le\u010denje\" \/>\n<meta property=\"og:description\" content=\"Jedan od najva\u017enijih aspekata le\u010denja epilepsije predstavlja primena antiepilepti\u010dkih lekova kod \u017eena u reproduktivnom periodu. 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