In March 2018 the EMA announced stronger measures aimed at avoiding the exposure of babies to valproate medicines in the womb. In the context of brain abscesses, anticonvulsants (including valproate medicines) are used prophylactically. Under the new restrictions, valproate medicines are contraindicated in epilepsy during pregnancy due to the high risk of congenital malformations and developmental problems in the child. However, the EMA recognises that for some women with epilepsy it may not be possible to stop valproate and they may have to continue treatment during pregnancy with appropriate specialist care.
In addition, valproate medicines must not be used in female patients of childbearing potential unless there is a pregnancy prevention programme in place that includes:
An assessment of the patient's potential for becoming pregnant
Pregnancy tests before starting and during treatment as needed
Counselling about the risks of valproate treatment and the need for effective contraception throughout treatment
A review of ongoing treatment by a specialist at least annually
A risk acknowledgement form that patients and prescribers will go through at each such annual review to confirm that appropriate advice has been given and understood.
The EMA said the new measures were put in place because of evidence suggesting that information on the risks of valproate use in pregnancy was still not getting through to women despite earlier steps aimed at ensuring this.See Management: approach See Management: treatment algorithm
Potentially life-threatening condition, with clinical and radiological presentation similar to central nervous system tumour. Requires early recognition for optimal outcome.
Lesions may be single or multi-focal. Aetiological agents may be bacterial, fungal, and parasitic.
Treatments include appropriate antimicrobial agents, support in an intensive care unit, and possible surgical evacuation. Surgery involves either image-guided aspiration or craniotomy with resection of the abscess cavity.
Patients must be followed up with serial imaging until their lesions have completely resolved.
Prognosis is most closely related to the patient's neurological status at presentation.
Brain abscess is a suppurative collection of microbes (most often bacterial, fungal, or parasitic) within a gliotic capsule occurring within the brain parenchyma. Lesions may be single or multi-focal.
Department of Neurosurgery
SUNY Upstate Medical University
WAH is an author of a number of references cited in this monograph.
Dr Walter A. Hall would like to gratefully acknowledge Dr Peter D. Kim, a previous contributor to this monograph. PDK declares that he has no competing interests.
Professor and Head
Department of Neurosurgery
University of Minnesota
SH and WAH were colleagues on a faculty of the University of Minnesota between 1991 and 1997 and again between 2004 and 2006. They have coauthored articles on neurosurgical infection.
Department of Neurological Sciences
Institute of Neurology C. Mondino
SR declares that she has no competing interests.
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