Minor/Major Congenital Malformations and Neurodevelopmental Outcomes in Children Prenatally Exposed to Levetiracetam, Lamotrigine, and Carbamazepine Monotherapy.

OBJECTIVES: The relationship of older antiseizure drugs with congenital malformations has been known for many years. Studies are mostly limited to major malformations and few studies have investigated minor malformations. In recent years, the long-term cognitive and behavioral effects of these drugs have also come to the fore. The aim of our study was to evaluate the incidence of major and minor congenital malformations and neurodevelopmental outcomes in children prenatally exposed to levetiracetam (LEV), lamotrigine (LTG), and carbamazepine (CBZ) monotherapy. METHODS: This was a prospective observational study conducted in two university hospital epilepsy centers. It included 32 pregnant women who were continuously treated with LEV, LTG, or CBZ from conception throughout pregnancy. Children were followed up from birth until 18 months. Neurodevelopmental outcomes were evaluated with the Ages and Stages Questionnaire and Denver Developmental Screening Test. RESULTS: Eighteen of the patients were on LEV, 10 were on LTG, and 4 were on CBZ. Diaphragmatic hernia was detected in a child. At least one minor anomaly was observed in 58.1% of the patients. More than 80% of children were normal in the Ages and Stages Questionnaire. CONCLUSIONS: The risk of major congenital malformations is lower with newer antiseizure drugs. We found a high incidence of minor ones. However, because the population prevalence of minor malformations is also variable, more studies are needed to confirm the results. Neurodevelopmental outcomes were favorable with LTG and LEV and slightly unfavorable with CBZ. Longer-term follow-up with large groups of children is required to reach more reliable results.

Successful treatment with therapeutic plasmapheresis of a pediatric patient with Guillain-Barré syndrome associated with neurobrucellosis.

Brucellosis is a multisystemic disease that can present with multiple signs and symptoms. Rarely, brucellosis can manifest as neurobrucellosis, with central or peripheral nervous system involvement. Guillain-Barré syndrome (GBS) is a post-infectious autoimmune disease that progresses rapidly, causing ascending muscle weakness, and is accompanied by areflexia/hyporeflexia. Regarding GBS etiology, it is thought to be an autoimmune disease, triggered by a previous bacterial or viral infection. There are a few Brucella-associated GBS case reports in the literature and in our opinion, only one of them is a pediatric patient. Herein we reported a case of GBS associated with neurobrucellosis, who was successfully treated with therapeutic plasmapheresis (TP) due to poor response to IVIG treatment.

Reproductive outcome of septate uterus after hysteroscopic metroplasty.

We evaluated the reproductive outcome after hysteroscopic metroplasty in the patients with septate uterus. The reproductive performance of 361 patients with septate uterus during the follow-up period of 18 months after the surgery was analyzed retrospectively for a period of 10 years. A total of 180 (49.8%) pregnancies were achieved after metroplasty during the follow-up period of 18 months. Of the 180 pregnancies 117 (57.2%) reached to term and 34 (18.8%) ended in preterm delivery and the remaining 29 (16%) resulted in abortion. Of the preterm babies 18 (52.9%) were able to live. We obtained 135 (75%) live babies totally. Hysteroscopic metroplasty improves the reproductive performance of septate uterus significantly especially in the cases with recurrent pregnancy loss and should be considered highly as a corrective approach for such patients.