95. low pressure headache not low csf pressure appears to predict immediate resolution of idiopathic...

1
94. Antiepileptic drug polytherapy issues in pregnancy Frank J. E Vajda a , Alison A. Hitchcock b , Janet E. Graham b , Terence J. O’Brien c , Cecilie M. Lander d , Mervyn J. Eadie e a Royal Melbourne Hospital, University of Melbourne, VIC b Royal Melbourne Hospital, VIC c Royal Melbourne Hospital, University of Melbourne, VIC d Royal Brisbane Hospital, University of Queensland, QLD e University of Queensland, QLD Aim: To assess the relative risks of antiepileptic drug (AED) poly- therapy and monotherapy in relation to foetal malformation during human pregnancy. Methods: Statistical analysis of data from the Australian Preg- nancy Register and from the literature. Results: In the Australian Register,791 of 1073 AED exposed preg- nancies received AED monotherapy (73.7%), and 282 AED poly- therapy (26.3%). In the monotherapy group there were 44 pregnancies with foetal malformations detected by the neonatal per- iod (5.18%) and 62 (7.84%) reported at 1 year post-natally: in the polytherapy group the corresponding figures were 11 (3.90%) and 15 (5.32%). For pregnancies involving polytherapy as compared with monotherapy, the Relative Risk (RR) value for associated foetal mal- formations was 0.75 (95% CI = 0.38, 1.44) as determined neonatally, and 0.68 (95% CI = 0.39, 1.17) as determined after the post-natal year.In 4 of the 14 publications from the literature the individual RR value calculated from published data was statistically signifi- cantly higher for the polytherapy group,in none statistically signifi- cantly lower, and in only 3 below 1.0. The Australian RR value was appreciably lower than the published ones. The risk was statistically significantly less overall, and also less for a given valproate dose, when valproate was co-administered with other AEDs, in particular lamotrigine. Conclusions: It may be unwise to generalise regarding foetal haz- ards of AED polytherapy versus monotherapy without assessment of the role of valproate. At the same dose, valproate in polytherapy, particularly if lamotrigine is involved, may be significantly less haz- ardous for foetal development than valproate monotherapy. doi:10.1016/j.jocn.2010.07.095 95. Low pressure headache not low CSF pressure appears to predict immediate resolution of idiopathic intracranial hyper- tension (IIH) Peter Gates, Jakob Christiansen, Gillian Skardoon, Kate Bryan Neuroscience Department, Geelong Hospital Barwon Health, VIC Background: The aetiology and underlying pathology of IIH is unknown. Some patients respond to an lumbar puncture (LP) but why has not been clear. Aim: To examine the effect of reducing CSF pressure to < or = 10 cm H 2 O in patients with IIH. Method: A study of 31 patients seen at the Geelong hospital between 1998 and 2010 with IIH. (defined as headache, papilloe- dema and CSF pressure > 25 cm H 2 O). Results: Closing pressure was documented in a total of 57 of 83 LP’s in the 31 patients; in 7 patients no closing pressure was recorded. A closing CSF pressure of 10 or less was recorded after 14 LP’s in 10 cases. In 4 of these patients the IIH resolved whilst in 6 it persisted. The 4 cases that resolved did so after developing a low-pressure headache. The IIH resolved in another 6 patients who developed a low-pressure headache (4 after LP, 1 after lumbar drain and one with a VP shunt) where a closing CSF pressure of 10 or less was not recorded. Rapid resolution of IIH did not occur in any patient after an LP in the absence of low-pressure headache. One patient had a recurrence after 2 years that coincided with regaining weight, all others remain free of symptoms 1 month to 10 years later (average 3 years), 4 patients for more than 5 years. Conclusion: Low-pressure headache not just low CSF closing pressure appears to predict response to LP in IIH. In an absence of knowing whether the block to CSF resorption is physiological or pathological a larger multi-centre study is required to assess whether this applies to all patients with IIH. doi:10.1016/j.jocn.2010.07.096 1638 Abstracts / Journal of Clinical Neuroscience 17 (2010) 1610–1638

Upload: peter-gates

Post on 25-Oct-2016

216 views

Category:

Documents


2 download

TRANSCRIPT

Page 1: 95. Low pressure headache not low CSF pressure appears to predict immediate resolution of idiopathic intracranial hypertension (IIH)

94. Antiepileptic drug polytherapy issues in pregnancyFrank J. E Vajda a, Alison A. Hitchcock b, Janet E. Graham b,Terence J. O’Brien c, Cecilie M. Lander d, Mervyn J. Eadie e

a Royal Melbourne Hospital, University of Melbourne, VICb Royal Melbourne Hospital, VICc Royal Melbourne Hospital, University of Melbourne, VICd Royal Brisbane Hospital, University of Queensland, QLDe University of Queensland, QLD

Aim: To assess the relative risks of antiepileptic drug (AED) poly-therapy and monotherapy in relation to foetal malformation duringhuman pregnancy.

Methods: Statistical analysis of data from the Australian Preg-nancy Register and from the literature.

Results: In the Australian Register,791 of 1073 AED exposed preg-nancies received AED monotherapy (73.7%), and 282 AED poly-therapy (26.3%). In the monotherapy group there were 44pregnancies with foetal malformations detected by the neonatal per-iod (5.18%) and 62 (7.84%) reported at 1 year post-natally: in thepolytherapy group the corresponding figures were 11 (3.90%) and15 (5.32%). For pregnancies involving polytherapy as compared withmonotherapy, the Relative Risk (RR) value for associated foetal mal-formations was 0.75 (95% CI = 0.38, 1.44) as determined neonatally,and 0.68 (95% CI = 0.39, 1.17) as determined after the post-natalyear.In 4 of the 14 publications from the literature the individualRR value calculated from published data was statistically signifi-cantly higher for the polytherapy group,in none statistically signifi-cantly lower, and in only 3 below 1.0. The Australian RR value wasappreciably lower than the published ones. The risk was statisticallysignificantly less overall, and also less for a given valproate dose,when valproate was co-administered with other AEDs, in particularlamotrigine.

Conclusions: It may be unwise to generalise regarding foetal haz-ards of AED polytherapy versus monotherapy without assessment ofthe role of valproate. At the same dose, valproate in polytherapy,particularly if lamotrigine is involved, may be significantly less haz-ardous for foetal development than valproate monotherapy.

doi:10.1016/j.jocn.2010.07.095

95. Low pressure headache not low CSF pressure appears topredict immediate resolution of idiopathic intracranial hyper-tension (IIH)Peter Gates, Jakob Christiansen, Gillian Skardoon, Kate Bryan

Neuroscience Department, Geelong Hospital Barwon Health, VIC

Background: The aetiology and underlying pathology of IIH isunknown. Some patients respond to an lumbar puncture (LP) butwhy has not been clear.

Aim: To examine the effect of reducing CSF pressureto < or = 10 cm H2O in patients with IIH.

Method: A study of 31 patients seen at the Geelong hospitalbetween 1998 and 2010 with IIH. (defined as headache, papilloe-dema and CSF pressure > 25 cm H2O).

Results: Closing pressure was documented in a total of 57 of 83LP’s in the 31 patients; in 7 patients no closing pressure wasrecorded. A closing CSF pressure of 10 or less was recorded after14 LP’s in 10 cases. In 4 of these patients the IIH resolved whilst in6 it persisted. The 4 cases that resolved did so after developing alow-pressure headache. The IIH resolved in another 6 patients whodeveloped a low-pressure headache (4 after LP, 1 after lumbar drainand one with a VP shunt) where a closing CSF pressure of 10 or lesswas not recorded. Rapid resolution of IIH did not occur in any patientafter an LP in the absence of low-pressure headache. One patient hada recurrence after 2 years that coincided with regaining weight, allothers remain free of symptoms 1 month to 10 years later (average3 years), 4 patients for more than 5 years.

Conclusion: Low-pressure headache not just low CSF closingpressure appears to predict response to LP in IIH. In an absence ofknowing whether the block to CSF resorption is physiological orpathological a larger multi-centre study is required to assesswhether this applies to all patients with IIH.

doi:10.1016/j.jocn.2010.07.096

1638 Abstracts / Journal of Clinical Neuroscience 17 (2010) 1610–1638