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01-09-2018 | Original Article

The course of epilepsy and seizure control in pregnant women

Authors: Melikova Shahla, Bagirova Hijran, Magalov Sharif

Published in: Acta Neurologica Belgica | Issue 3/2018

Abstract

To investigate the course of epilepsy and seizure control during pregnancy. 105 pregnant women with epilepsy were studied prospectively during the period from 2013 to 2017. The average age at the onset of epilepsy was 17.4 ± 0.5 years. Seizures during pregnancy were observed in 76 (72.4 ± 4.4%) women. Eleven (10.5 ± 3.0%) women had their first seizure during current pregnancy. Among those 94 women who were diagnosed with epilepsy before pregnancy, 29 (30.9 ± 4.8%) remained seizure free; seizure frequency increased in 27 (28.7 ± 4.7%), decreased in 24 (25.5 ± 4.5%) women, in 14 (14.9 ± 3.7%) remained unchanged. Among 15 women who were seizure free for the 1 year prior to pregnancy 11 (73.3 ± 11.4%) women remained seizure free during pregnancy. The worsening in seizure control during pregnancy occurred in 22 (35.5 ± 6.1%) of 62 women with focal epilepsy and 5 (15.6 ± 6.4%) of 32 with idiopathic generalized epilepsy (OR 2.97, 95% CI 1.0–8.81). Non-compliance with the antiepileptic drug therapy was observed in 20 (19.0 ± 3.8%) pregnant women, seizure frequency increased in 18 (90.0 ± 6.7%) of them compared with 5 (9.8 ± 4.2%) of 51 of those who followed correct antiepileptic drug regimen (p < 0.001). The risk of seizures during pregnancy was lower in women who were seizure-free for the 1 year prior to pregnancy; focal epilepsy was associated with an increased risk of seizure relapse during pregnancy; non-compliance with the antiepileptic drug therapy and inappropriate treatment may lead to worsening of seizure control and to the status epilepticus during pregnancy.

Morrell MJ (2002) Epilepsy in women. Am Fam Physician 66(8):1489–1494PubMed

Tomson T, Battino D, Bonizzoni E et al (2011) EURAP study group. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol 10(7):609–617CrossRefPubMed

Borgelt LM, Hart FM, Bainbridge JL (2016) Epilepsy during pregnancy: focus on management strategies. Int J Womens Health 8:505–517CrossRefPubMedPubMedCentral

Patel SI, Pennell PB (2016) Management of epilepsy during pregnancy: an update. Ther Adv Neurol Disord 9(2):118–129CrossRefPubMed

Schmidt D (1982) The effect of pregnancy on the natural history of epilepsy. A review of literature. In: Janz D, Dam M, Bossi L, Helge H, Richens A, Schmidt D (eds) Epilepsy, pregnancy, and the child. Raven Press, Ltd., New York, pp 3–14

EURAP Study (2006) Seizure control and treatment in pregnancy: observations from the EURAP Epilepsy Pregnancy Registry. Neurology 66:354–360CrossRef

Thomas SV, Syam U, Devy JS (2012 May) Predictors of seizures during pregnancy in women with epilepsy. Epilepsia 53(5):85–88CrossRef

Harden CL, Hopp J, Ting TY et al (2009) Management issues for women with epilepsy—Focus on pregnancy (an evidence based review): I.Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia 50:1229–1236CrossRefPubMed

Bardy AH (1987) Incidence of seizures during pregnancy, labor and puerperium in epileptic women: a prospective study. Acta Neurol Scand 75:356–360CrossRefPubMed

10.

Tanganelli P, Regesta G (1992) Epilepsy, pregnancy, and major birth anomalies: an Italian prospective, controlled study. Neurology 42(4 Suppl. 5):89–93PubMed

11.

Tomson T, Lindbom U, Ekqvist B, Sundqvist A. Epilepsy and pregnancy: a prospective study of seizure control in relation to free and total plasma concentrations of carbamazepine and phenytoin. Epilepsia 35(1):122–130 (1994)CrossRefPubMed

12.

Ozdemir O, Mustafa E, Sari A, Kurt et al (2015) Pregnancy outcome of 149 pregnancies in women with epilepsy: experience from a tertiary care hospital. Interv Med Appl Sci 7(3):108–113PubMedPubMedCentral

13.

Viinikainen K, Heinonen S, Eriksson K, Kalviainan R (2006) Community—based, prospective, controlled study of obstetric and neonatal outcome of 179 pregnancies in women with epilepsy. Epilepsia 47:186–192CrossRefPubMed

14.

Battino D, Tomson T, Bonizzoni E et al (2013) Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia 54(9):1621–1627CrossRefPubMed

15.

Thomas SV (2006) Management of epilepsy and pregnancy. J Postgrad Med 52(1):57–64PubMed

16.

Yakunina AV, Poverennova IE, Veldiaksova ED (2017) The peculiarities of the focal epilepsy during pregnancy and after childbirth. Sib Med Rev 2017(1):63–69CrossRef

17.

van Loenen NTVM et al (2004) New onset seizures in pregnancy caused by an unexpected neurologic disorder. Eur J Obstet Gynecol Reprod Biol 10(1):109–111CrossRef

18.

Sveberg L, Svalheim S, Taubøll E (2015 May) The impact of seizures on pregnancy and delivery. Seizure 28:35–38CrossRefPubMed

19.

Beach RL, Kaplan PW (2008) Seizures in pregnancy: diagnosis and management. Int Rev Neurobiol 83:259–271CrossRefPubMed

20.

Gjerde IO, Strandjord RE, Ulstein M (1988) The course of epilepsy during pregnancy: a study of 78 cases. Acta Neurol Scand 78(3):198–205CrossRefPubMed

21.

Vajda FJE, Hitchcock A, Graham J et al (2008) Seizure control in antiepileptic drug-treated pregnancy. Epilepsia 49(1):172–176CrossRefPubMed

22.

Schmidt D, Canger R, Avanzini G et al (1983) Change of seizure frequency in pregnant epileptic women. J Neurol Neurosurg Psychiatry 146:751–755CrossRef

23.

Wu M, Hao N, Yan B, Chi X, Zhou D (2016) Status epilepticus in pregnant women with epilepsy after valproate adjustment: a case series. Seizure 43:39–41CrossRefPubMed

24.

Kasai M, Aoki S, Kobayashi N, Hirahara F, Takahashi T (2016) Status epilepticus due to brain tumor during pregnancy. Clin Case Rep 4(4):333–335CrossRefPubMedPubMedCentral

Title: The course of epilepsy and seizure control in pregnant women
Authors: Melikova Shahla
Bagirova Hijran
Magalov Sharif
Publication date: 01-09-2018
Publisher: Springer International Publishing
Published in: Acta Neurologica Belgica / Issue 3/2018
Print ISSN: 0300-9009
Electronic ISSN: 2240-2993
DOI: https://doi.org/10.1007/s13760-018-0974-0

At a glance: The STEP trials

Springer Medicine

The course of epilepsy and seizure control in pregnant women

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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