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Neurological Sciences
Published in: Neurological Sciences 3/2022

Open Access 01-03-2022 | Epilepsy | Original Article

Levetiracetam, lamotrigine and carbamazepine: which monotherapy during pregnancy?

Authors: Luisa Mari, Fabio Placidi, Andrea Romigi, Mario Tombini, Chiara Del Bianco, Martina Ulivi, Claudio Liguori, Natalia Manfredi, Alessandro Castelli, Nicola Biagio Mercuri, Francesca Izzi

Published in: Neurological Sciences | Issue 3/2022

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Abstract

Objective

Epilepsy treatment during pregnancy is still challenging. The study is aimed at comparing the efficacy and safety of carbamazepine (CBZ), lamotrigine (LTG) and levetiracetam (LEV) monotherapies during pregnancy in women with focal (FE) or generalized (GE) epilepsy.

Methods

A multicentre retrospective study was conducted to evaluate seizures frequency and seizure freedom (SF) rate during 3 months before pregnancy, each trimester of gestation and post-partum period in women on monotherapy with CBZ, LTG and LEV.

Results

Fifty-seven pregnancies (45 FE, 12 GE) on monotherapy (29 CBZ, 11 LTG, 17 LEV) were included. A significant reduction of seizure frequency was found in the first trimester of pregnancy as compared with that one before pregnancy (p = 0.004), more evident in GE (p = 0.003) and in LEV group (p = 0.004). The SF rate significantly increased in the first trimester in comparison to that one before pregnancy and persisted in the post-partum period in the whole sample (p < 0.001) and in women on LEV (p = 0.004). Besides, 88.57% of SF women before pregnancy remained unchanged during gestation and the post-partum period. One major heart malformation in CBZ and no major malformations in LTG and LEV groups were found.

Conclusions

A better clinical outcome during pregnancy emerged since the first trimester in comparison to the before-pregnancy period, mostly evident in women with GE and LEV therapy, reinforcing the hypothesis of a protective role of pregnancy versus seizures. SF before pregnancy represents a significant predictive factor of good clinical outcome during gestation and the post-partum period. Compared to CBZ, LTG and LEV showed a better safety profile.
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Metadata
Title
Levetiracetam, lamotrigine and carbamazepine: which monotherapy during pregnancy?
Authors
Luisa Mari
Fabio Placidi
Andrea Romigi
Mario Tombini
Chiara Del Bianco
Martina Ulivi
Claudio Liguori
Natalia Manfredi
Alessandro Castelli
Nicola Biagio Mercuri
Francesca Izzi
Publication date
01-03-2022
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 3/2022
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-021-05542-2

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