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Vukovic-Cvetkovic V, Beier D, Buchgreitz L, Korsbaek JJ, Jensen RH. Management and Outcome of Pregnancy in Patients With Idiopathic Intracranial Hypertension: A Prospective Case Series Study. Neurol Clin Pract 2024; 14:e200226. [PMID: 38213400 PMCID: PMC10781565 DOI: 10.1212/cpj.0000000000200226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/10/2023] [Indexed: 01/13/2024]
Abstract
Background and Objectives Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure without an identifiable cause that mostly affects obese persons of childbearing age. In this prospective case series, we have evaluated the overall outcome of pregnancy and birth in participants with IIH and their newborn children. We also provide a proposal for the management of pregnant persons with IIH. Methods In this observational study, neuro-ophthalmological findings, the course of IIH-related symptoms, disease management, and pregnancy outcomes were evaluated. The participants were divided into 3 groups according to the course of the disease during pregnancy: stable, worsened, and new diagnosed. Furthermore, the type of delivery and outcome of newborn children such as gestational age, weight at birth, and the presence of asphyxia were compared between the groups. Results We observed 47 pregnancies in 42 participants; 2 had spontaneous abortions. There were 19 (47%) participants in the stable, 18 (45%) in the worsened, and 3 (8%) in the new diagnosed groups, respectively. A relapse of IIH occurred in 2 (5%). Worsening of IIH-related symptoms was experienced by 18/37 (49%) participants: headache by 17/18 (94%), tinnitus by 11/18 (61%), and vision by 7/18 (39%) (mostly in the first and second trimester). In 8/18 (44%), the symptoms were transient or alleviated in the second and third trimester. Body mass index before and after pregnancy did not significantly differ among the groups. A total of 8 participants were treated with acetazolamide. The frequency of cesarean section was 17/40 (43%). Preterm delivery occurred in 22%. No increased risk of asphyxia was observed, and all infants, but one, were healthy. Discussion Worsening of headache, tinnitus, and/or vision were experienced by half of pregnant participants with IIH, mostly transient in the first and second trimester, rarely required specific treatment, and were not identified as a relapse of IIH. There was no difference in gestational age and weight at birth in children among the groups, and no perinatal asphyxia was noted. Weight gain in the participants was not identified as a risk factor for relapse of IIH in pregnancy. The rate of cesarean and preterm delivery was higher than in the non-IIH population. A proposal for the management of IIH in pregnancy is provided.
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Affiliation(s)
- Vlasta Vukovic-Cvetkovic
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| | - Dagmar Beier
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| | - Line Buchgreitz
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| | - Johanne J Korsbaek
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
| | - Rigmor H Jensen
- Danish Headache Center (VV-C, JJK, RHJ), The Rigshospitalet-Glostrup, University of Copenhagen; Department of Neurology (DB), Odense University Hospital; Department of Clinical Research (DB), University of Southern Denmark; OPEN (DB), Odense Patient Data Explorative Network, Odense University Hospital; and Department of Obstetrics (LB), Rigshospitalet, University of Copenhagen, Denmark
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Calado AM, Seixas F, Pires MDA. Updating an Overview of Teratology. Methods Mol Biol 2024; 2753:1-38. [PMID: 38285332 DOI: 10.1007/978-1-0716-3625-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
In this chapter, the authors aim to update an overview of the principles of teratology, beginning with the definition of teratology, the critical point at which this process occurs, and some of the most common etiological agents that improve our understanding of teratology.Modern teratology has greatly improved in recent years with advances in new methods in molecular biology, toxicology, animal laboratory science, and genetics, increasing our knowledge of ambient influences. Nevertheless, there is a lot to do to reduce the influence of hazardous intervening agents, whether they target our genetics or not, that can negatively affect pregnancy and induce congenital development disorders, including morphological, biochemical, or behavioral defects.Certain agents might indeed be related to certain defects, but we have not been able to identify the cause of most congenital defects, which highlights the importance of finding and testing out new genetics techniques and conducting laboratory animal science to unravel the etiology and pathogenicity of each congenital defect.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Kumari R, Saha BC, Onkar A, Ambasta A, Kumari A. Management of glaucoma in pregnancy - balancing safety with efficacy. Ther Adv Ophthalmol 2021; 13:25158414211022876. [PMID: 34263134 PMCID: PMC8243098 DOI: 10.1177/25158414211022876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Glaucoma and pregnancy is an uncommon combination, but it constitutes a very challenging situation for the treating doctor. The challenge is not only controlling the intraocular pressure and preventing glaucoma progression in the mother, but also having to deal with her mental stress and anxiety regarding the safety of her child. The situation is further worsened by the lack of definite guidelines as to how to deal with such patients. Relative rarity of glaucoma in this population restricts any large prospective randomized clinical trials or any large systematic studies. Moreover, none of the existing anti-glaucoma medications is absolutely safe in pregnancy. Current practice patterns depend on some case reports, a few observational studies and a few animal studies that attempt at determining the safety and efficacy of the available medicines. These are then prescribed on the basis of their relative safety in any particular stage of pregnancy or lactation. Newer medications that were released recently in 2018, such as Vyzulta and Rhopressa, presently have limited data to support their safety for use during pregnancy. Laser trabeculoplasty, conventional filtration surgery (of course without anti-metabolites), and minimally invasive glaucoma surgery represent a few non-pharmacological management options. Surgical procedures such as trabeculectomy and tube-shunts or collagen matrix implants, and newer minimally invasive glaucoma surgery procedures such as the gelatin stents are currently being explored and may prove to be viable solutions for severe glaucoma during pregnancy, although they too have their own inherent drawbacks. Management of glaucoma during pregnancy and lactation requires careful consideration of the disease status, gestational stage, US Food and Drug Administration classification and guidelines, and potential benefits and limitations of the various therapeutic modalities. This review focuses on the importance of a multidisciplinary team approach, starting with preconception planning and counseling, determining the treatment options depending on the stage of glaucoma and of pregnancy, and emphasizes the involvement of the patients, their obstetrician, and pediatrician through active discussion regarding the various medical, laser, or surgical modalities currently available or under exploration for use during pregnancy and lactation. The ultimate aim is to achieve an optimal balance between the risks and benefits of any type of intervention, and to customize treatment on an individual basis in order to achieve the best outcomes for both mother and fetus.
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Affiliation(s)
- Rashmi Kumari
- Assistant Professor, Department of
Ophthalmology, Indira Gandhi Institute of Medical Sciences, House no. O/13,
Ashiyana Nagar Phase 1, Patna 800025, Bihar, India
| | - Bhawesh Chandra Saha
- Department of Ophthalmology, All India
Institute of Medical Sciences Patna, Patna, India
| | - Abhishek Onkar
- Department of Ophthalmology, All India
Institute of Medical Sciences Deoghar, Deoghar, India
| | - Anita Ambasta
- Regional Institute of Ophthalmology, Indira
Gandhi Institute of Medical Sciences, Patna, India
| | - Akanchha Kumari
- Department of Ophthalmology, All India
Institute of Medical Sciences Patna, Patna, India
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A Novel Missense Variant of TP63 Heterozygously Present in Split-Hand/Foot Malformation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4215632. [PMID: 33294441 PMCID: PMC7714569 DOI: 10.1155/2020/4215632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/29/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
Background Split-hand/foot malformation (SHFM) is a severe congenital disability mainly characterized by the absence or hypoplasia of the central ray of the hand/foot. To date, several candidate genes associated with SHFM have been identified, including TP63, DLX5, DLX6, FGFR1, and WNT10B. Herein, we report a novel variant of TP63 heterozygously present in affected members of a family with SHFM. Methods This study investigated a Chinese family, in which the proband and his son suffered from SHFM. The peripheral blood sample of the proband was used to perform whole-exome sequencing (WES) to explore the possible genetic causes of this disease. Postsequencing bioinformatic analyses and Sanger sequencing were conducted to verify the identified variants and parental origins on all family members in the pedigree. Results By postsequencing bioinformatic analyses and Sanger sequencing, we identified a novel missense variant (NM_003722.4:c.948G>A; p.Met316Ile) of TP63 in this family that results in a substitution of methionine with isoleucine, which is probably associated with the occurrence of SHFM. Conclusion A novel missense variant (NM_003722.4:c.948G>A; p.Met316Ile) of TP63 in SHFM was thus identified, which may enlarge the spectrum of known TP63 variants and also provide new approaches for genetic counselling of families with SHFM.
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Abstract
PURPOSE OF REVIEW This article aims to review the current and upcoming treatment options of primary muscle channelopathies including the non-dystrophic myotonias and periodic paralyses. RECENT FINDINGS The efficacy of mexiletine in the treatment of myotonia is now supported by two randomised placebo-controlled trials, one of which utilised a novel aggregated n-of-1 design. This has resulted in licencing of the drug via orphan drug status. There is also good evidence that mexiletine is well tolerated and safe in this patient group without the need for intensive monitoring. A range of alternative antimyotonic treatment options include lamotrigine, carbamazepine and ranolazine exist with variable evidence base. In vitro studies have shown insight into reasons for treatment failure of some medications with certain genotypes opening the era of mutation-specific therapy such as use of flecainide. In the periodic paralyses, the ability of MRI to distinguish between reversible oedema and irreversible fatty replacement makes it an increasingly useful tool to guide and assess pharmacological treatment. Unfortunately, the striking efficacy of bumetanide in hypokalaemic periodic paralysis animal models was not replicated in a recent pilot study in humans. SUMMARY The treatment of skeletal muscle channelopathies combines dietary and lifestyle advice together with pharmacological interventions. The rarity of these conditions remains a barrier for clinical studies but the example of the aggregated n-of-1 trial of mexiletine shows that innovative trial design can overcome these hurdles. Further research is required to test efficacy of drugs shown to have promising characteristics in preclinical experiments such as safinamide, riluzule and magnesium for myotonia or bumetanide for hypokalaemic periodic paralysis.
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Affiliation(s)
- Nantaporn Jitpimolmard
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
- Rehabilitation Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Emma Matthews
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
- Atkinson-Morley Neuromuscular Centre, St George’s University Hospitals Foundation Trust, London, UK
| | - Doreen Fialho
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
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Abstract
In this chapter, we provide an overview of the basic principles of teratology, beginning with its definition, the critical point for teratogenesis to occur and the most evident etiological agents to improve the understanding of this science.Teratology is a recent science that began in the early twentieth century, and has greatly improved over the recent years with the advancements in molecular biology, toxicology, animal laboratory science, and genetics, as well as the improvement on the knowledge of the environmental influences.Nevertheless, more work is required to reduce the influence of hazardous products that could be deleterious during pregnancy, thus reducing teratogenic defects in the newborn. While some teratogenic defects are attributed to their agents with certainty, the same for a lot of other such defects is lacking, necessitating consistent studies to decipher the influence of various teratogenic agents on their corresponding teratogenic defects. It is here that the laboratory animal science is of great importance both in the present and in the future.
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Affiliation(s)
- Ana M Calado
- Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.,Centro de Ciência Animal e Veterinária (CECAV), Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal. .,Centro de Ciência Animal e Veterinária (CECAV), Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Ashi M, Assur R, Awan B, Aljaaly H. Bilateral split hand foot malformation in siblings: Case series. Int J Surg Case Rep 2017; 44:114-117. [PMID: 29499514 PMCID: PMC5910499 DOI: 10.1016/j.ijscr.2017.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Split Hand-Foot malformation (SHFM) is a congenital limb defect that affects the central rays of the hands and/or feet. It is a rare condition that has genetic and environmental etiologies. It ranges in severity depending on the extent of the malformation. We report on two siblings with severe SHFM affecting all limbs. METHODS We described two cases of siblings with SHFM and discuss the possible causes of the condition. This research did not require ethical approval due to the institute not requiring it for this type of study. RESULTS Case 1 is a 7-year-old boy, and case 2 is his 4-year-old brother. They are both medically and surgically free. They had normal growth and development and were products of a consanguineous marriage. They both presented with bilateral deformities of the hands and feet, and had no previous family history of congenital anomalies. CONCLUSION SHFM may occur as a result of consanguineous marriage, genetic mutation, and chemical exposure. Genetic counseling and thorough assessment of associated anomalies is mandatory.
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Affiliation(s)
- Mohammed Ashi
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Rehab Assur
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Basim Awan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hattan Aljaaly
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Vaajanen A, Vapaatalo H. A Single Drop in the Eye - Effects on the Whole Body? Open Ophthalmol J 2017; 11:305-314. [PMID: 29299077 PMCID: PMC5725525 DOI: 10.2174/1874364101711010305] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/12/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction: Although the local adverse effects of ophthalmic drugs, including allergic reactions, are well recognized, less is known about the systemic side- effects of eye drops, especially during pregnancy, breast-feeding and early childhood. Ophthalmologists should also be aware of unusual, in some cases even life-threatening, effects of commonly used eye drops. Conclusion: This brief review outlines the routes of systemic absorption and the kinetics of active components present in eye drops, and identifies the clinically relevant systemic adverse effects.
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Affiliation(s)
- Anu Vaajanen
- Department of Ophthalmology, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland.,SILK, Department of Ophthalmology, School of Medicine, University of Tampere, 33014, Tampere, Finland
| | - Heikki Vapaatalo
- Medical Faculty, Pharmacology, University of Helsinki, P.O. Box 63, 00014, Helsinki, Finland
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Keskin-Arslan E, Kaplan YC. Comment on the case report "Possible association between acetazolamide administration during pregnancy and multiple congenital malformations". DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:3681-3683. [PMID: 27877019 PMCID: PMC5108495 DOI: 10.2147/dddt.s122748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Elif Keskin-Arslan
- Department of Pharmacology, School of Medicine, Izmir Katip Celebi University; Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey
| | - Yusuf Cem Kaplan
- Department of Pharmacology, School of Medicine, Izmir Katip Celebi University; Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey
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