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Ask the Expert: Teratogenicity Prevention

Activity provided by the American Epilepsy Society.
Recording date: June 20, 2017
Activity Launch date: June 28, 2017
Expiration date (nursing credits): June 28, 2019
Expiration date (physician and participation credits): June 28, 2020

Overview

Approximately one-quarter of patients with active epilepsy are females of childbearing age which necessitates treatment with medications that are known teratogens. Women of childbearing age who are exposed to anti-epileptic drugs (AEDs) are potentially increasing risks of congenital anomalies or birth defects.
Prescription drug exposure is a preventable cause of congenital malformation in infants and the precise risks for most AEDs and AED combinations are unknown. As a care providers, you must consider the benefits and risks of AEDs for your patients, including benefits of seizure reductions and risks of teratogenicity when recommending treatment options.

View this recorded webinar to learn more about options to reduce risks of teratogenicity, including AED dose optimization, vitamin supplementation and contraceptive options and how to explain teratogenic risk of AEDs on fetal development.

References:
Meador KJ, Loring DW. Developmental effects of antiepileptic drugs and the need for improved regulations. Neurology. 2016;86(3):297-306. doi:10.1212/WNL.0000000000002119.
Pennell PB. Too Complicated or So Simple: AED Type and AED Dose Matter for Pregnancy. Epilepsy Currents. 2012;12(2):63-65. doi:10.5698/1535-7511-12.2.63.

Learning Objectives

Following participation in this activity, the learner should be able to:
  • consider the benefits and risks of AEDs, including benefits of seizure reductions and risks of teratogenicity when recommending treatment options.
  • identify AEDs with high teratogenic risk.
  • explain teratogenic risk of AEDs on fetal development.
  • discuss options to reduce risks of teratogenicity, including AED dose optimization, vitamin supplementation and contraceptive options.

Target Audience

Epileptologists, neurologists, pharmacologists, advanced practice providers, nurses and epilepsy specialist allied health professionals 

Faculty

Moderator:
Dennis J. Dlugos, MD, Childrens Hospital of Philadelphia, Philadelphia, PA
Chair, AES Education and Professional Development Committee


Presenter:
Alison M. Pack, M.D., M.P.H., Columbia University Medical Center, New York

Disclosure Policy

It is the policy of the American Epilepsy Society to ensure balance, independence, objectivity and scientific rigor. All individuals involved in the selection, development and presentation of content are required to disclose any real or apparent conflicts of interest. Conflicts of interest will be resolved by AES prior to an educational activity being delivered to learners.

Faculty, Planning Committee, Reviewers’ Disclosures of Financial Relationships

In accordance with the ACCME Standards for Commercial Support, the AES requires that any person who is in a position to control content of a CME activity must disclose all relevant financial relationships that they have with a commercial interest. The following individuals contributed to this activity’s content.

Faculty & Planners
Dennis Dlugos, MD, Childrens Hospital of Philadelphia, Philadelphia, PA
Dr. Dlugos receives research funding from the NIH, the Pennsylvania Department of Health, and the Epilepsy Study Consortium. He has also given expert testimony in medico-legal cases.

Alison M. Pack, M.D., M.P.H., Columbia University Medical Center, New York
Dr. Pack has indicated she has no financial relationships with commercial interests to disclose.

Nurse Planner
Madona Plueger, APRN, ACNS-BC, Barrow Neurological Institute, Phoenix, Arizona
Ms. Plueger has indicated she has no financial relationships with commercial interests to disclose.

CME Reviewer
Ignacio Valencia, M.D.
Dr. Valencia has indicated he has no financial relationships with commercial interests to disclose.

American Epilepsy Society Staff Planner
Jessica A. Daniels, MNA
Ms. Daniels has indicated she has no financial relationships with commercial interests to disclose.

ACCME-defined Commercial Interest: Any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients.

Resolution of Conflicts of Interest

It is the policy of the American Epilepsy Society to ensure balance, independence, objectivity and scientific rigor. All persons involved in the selection, development and presentation of content are required to disclose any real or apparent conflicts of interest. In accordance with the ACCME Standards for Commercial Support of CME, the AES implemented the mechanisms of prospective peer review of this CME activity, to identify and resolve any conflicts. Additionally, the content of this activity is based on the best available evidence.

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Epilepsy Society and Montana Nurses Association. The American Epilepsy Society is accredited by the ACCME to provide continuing medical education for physicians.

This continuing nursing education activity was approved by the Montana Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.


Credit Designation

The American Epilepsy Society designates this enduring material internet activity for a maximum of .5 AMA PRA Category 1 Credit™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

International Credits: The American Medical Association has determined that non-US. licensed physicians who participate in this CME activity are eligible for AMA PRA Category 1 Credits™.

Physician Assistants: AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credits™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 0.5 hours of Category 1 credit for completing this program.

Nurses: This activity has been approved for 0.5 contact hours of continuing nursing education.

CME and CE Certificates
To receive credit for your participation in this activity, please complete the evaluation survey provided at the conclusion of the activity.


Unapproved Use Disclosure

The American Epilepsy Society requires CME authors to disclose to learners when products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not FDA approved); and any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. This information is intended solely for continuing medical education and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information. Information about pharmaceutical agents/devices that is outside of U.S. Food and Drug Administration approved labeling may be contained in this activity.

Disclaimer

This CME activity is for educational purposes only and does not constitute the opinion or endorsement of, or promotion by, the American Epilepsy Society. Reasonable efforts have been taken to present educational subject matter in a balanced, unbiased fashion, and in compliance with regulatory requirements. However, each activity participant must always use his or her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label, investigational and/or experimental uses.