Highlights
- •We compared seizure control in prepregnancy, pregnancy, and postpregnancy.
- •The main results were the seizure-free rates in the three periods mentioned above.
- •The seizure-free rates were 38.4%, 34.7%, and 43.9%, respectively.
- •There was no significant difference in seizure-free rates among the three periods.
Abstract
Seizure control in women with epilepsy (WWE) during pregnancy is a vital concern.
The aim of this study was to compare changes in seizure frequency and anti-seizure
medication (ASM ) therapy in WWE in a real-world setting over three epochs (prepregnancy,
pregnancy, and postpregnancy). We screened WWE who were pregnant between 1 January
2010 and 31 December 2020 from the epilepsy follow-up registry database of a tertiary
hospital in China. We reviewed and collected follow-up data for the following time
periods: 12 months before pregnancy (epoch 1), throughout pregnancy and the first
6 weeks postpartum (epoch 2), and from 6 weeks to 12 months postpartum (epoch 3).
Seizures were classified into two categories: tonic‒clonic/focal to bilateral tonic‒clonic
seizures and non-tonic‒clonic seizures. The main indicator was the seizure-free rate
over the three epochs. Using epoch 1 as a reference, we also compared the percentage
of women with an increased seizure frequency, as well as changes in ASM treatment,
in epochs 2 and 3. Ultimately, 271 eligible pregnancies in 249 women were included.
The seizure-free rates in epoch 1, epoch 2, and epoch 3 were 38.4%, 34.7%, and 43.9%,
respectively (P = 0.09). The top three ASMs used in the three epochs were lamotrigine,
levetiracetam, and oxcarbazepine. Using epoch 1 as a reference, the percentages of
women with increased frequencies of tonic‒clonic/focal to bilateral tonic‒clonic seizures
in epoch 2 and epoch 3 were 17.0% and 14.8%, respectively, while the percentages of
women with an increased frequency of non-tonic‒clonic seizures in epoch 2 and epoch
3 were 31.0% and 21.8% (P = 0.02). The percentage of women whose ASM dosages were
increased in epoch 2 was higher than that in epoch 3 (35.8% vs. 27.3%, P = 0.03).
The seizure frequency during pregnancy may not differ significantly from that during
prepregnancy and postpregnancy if WWE are treated according to the guidelines.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Epilepsy & BehaviorAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Management of epilepsy in women.Lancet Neurol. 2019; 18: 481-491https://doi.org/10.1016/s1474-4422(18)30495-2
- Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies.Neurology. 2017; 88: 296-303https://doi.org/10.1212/WNL.0000000000003509
- Maternal death in women with epilepsy: Smaller scope studies.Neurology. 2018; 91: e1716-e1720https://doi.org/10.1212/WNL.0000000000006426
- Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States.JAMA Neurol. 2015; 72: 981-988https://doi.org/10.1001/jamaneurol.2015.1017
- SUDEP and epilepsy-related mortality in pregnancy.Epilepsia. 2014; 55: e72-e74https://doi.org/10.1111/epi.12621
- Antiepileptic drug pharmacokinetics during pregnancy and lactation.Neurology. 2003; 61: S35-S42https://doi.org/10.1212/wnl.61.6_suppl_2.s35
- Ictal hypoxemia: A systematic review and meta-analysis.Seizure. 2018; 63: 7-13https://doi.org/10.1016/j.seizure.2018.10.011
- Epidemiology of maternal injuries during pregnancy in a population-based study, 1997-2005.J Womens Health (Larchmt). 2010; 19: 2211-2218https://doi.org/10.1089/jwh.2010.2160
- Seizure control and treatment in pregnancy: observations from the EURAP epilepsy pregnancy registry.Neurology. 2006; 66: 354-360https://doi.org/10.1212/01.wnl.0000195888.51845.80
- Predictors of seizures during pregnancy in women with epilepsy.Epilepsia. 2012; 53: e85-e88https://doi.org/10.1111/j.1528-1167.2012.03439.x
- Practice parameter update: management issues for women with epilepsy–focus on pregnancy (an evidence-based review): 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 American Epilepsy Society.Neurology. 2009; 73: 126-133https://doi.org/10.1212/WNL.0b013e3181a6b2f8
- Changes in Seizure Frequency and Antiepileptic Therapy during Pregnancy.N Engl J Med. 2020; 383: 2547-2556https://doi.org/10.1056/NEJMoa2008663
- Comparative Long-Term Effectiveness of a Monotherapy with Five Antiepileptic Drugs for Focal Epilepsy in Adult Patients: A Prospective Cohort Study.PLoS One. 2015; 10e0131566https://doi.org/10.1371/journal.pone.0131566
- Epilepsia. 1981; 22: 489-501https://doi.org/10.1111/j.1528-1157.1981.tb06159.x
- Epilepsia. 1989; 30: 389-399https://doi.org/10.1111/j.1528-1157.1989.tb05316.x
- Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009.Epilepsia. 2010; 51: 676-685https://doi.org/10.1111/j.1528-1167.2010.02522.x
- ILAE official report: a practical clinical definition of epilepsy.Epilepsia. 2014; 55: 475-482https://doi.org/10.1111/epi.12550
- ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology.Epilepsia. 2017; 58: 512-521https://doi.org/10.1111/epi.13709
- Instruction manual for the ILAE 2017 operational classification of seizure types.Epilepsia. 2017; 58: 531-542https://doi.org/10.1111/epi.13671
- 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. 2009; 50: 1229-1236https://doi.org/10.1111/j.1528-1167.2009.02128.x
Thangaratinam PS, Fong DF, McCorry DD. Epilepsy in pregnancy. Green-top Guideline No. 68 2016 [Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg68/]
- Epilepsies: diagnosis and management. Clinical guideline [CG137].National Institute for Clinical Excellence, London2018
- Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology.Epilepsia. 2017; 58: 522-530https://doi.org/10.1111/epi.13670
- Antiepileptic drug treatment in pregnancy: changes in drug disposition and their clinical implications.Epilepsia. 2013; 54: 405-414https://doi.org/10.1111/epi.12109
- Change of seizure frequency in pregnant epileptic women.J Neurol Neurosurg Psychiatry. 1983; 46: 751-755https://doi.org/10.1136/jnnp.46.8.751
- Incidence of seizures during pregnancy, labor and puerperium in epileptic women: a prospective study.Acta Neurol Scand. 1987; 75: 356-360https://doi.org/10.1111/j.1600-0404.1987.tb05459.x
- Seizure control in antiepileptic drug-treated pregnancy.Epilepsia. 2008; 49: 172-176
- Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry.Epilepsia. 2013; 54: 1621-1627https://doi.org/10.1111/epi.12302
- Prospective, case-control study on the effect of pregnancy on seizure frequency in women with epilepsy.Neurol Sci. 2015; 36: 79-83https://doi.org/10.1007/s10072-014-1908-0
- Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy.Epilepsy Behav. 2013; 29: 13-18https://doi.org/10.1016/j.yebeh.2013.06.026
- Predicting epileptic seizure control during pregnancy.Epilepsy Behav. 2018; 78: 91-95https://doi.org/10.1016/j.yebeh.2017.10.017
- The course of epilepsy during pregnancy: a study of 78 cases.Acta Neurol Scand. 1988; 78: 198-205https://doi.org/10.1111/j.1600-0404.1988.tb03646.x
- Epilepsy and pregnancy: a prospective study of seizure control in relation to free and total plasma concentrations of carbamazepine and phenytoin.Epilepsia. 1994; 35: 122-130https://doi.org/10.1111/j.1528-1157.1994.tb02921.x
- Comparative safety of antiepileptic drugs during pregnancy.Neurology. 2012; 78: 1692-1699https://doi.org/10.1212/WNL.0b013e3182574f39
- Dose-Dependent Risk of Malformations With Antiepileptic Drugs: An Analysis of Data From the EURAP Epilepsy and Pregnancy Registry.Ther Drug Monit. 2015; 37: 557-558https://doi.org/10.1097/FTD.0000000000000193
- Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study.Lancet Neurol. 2013; 12: 244-252https://doi.org/10.1016/s1474-4422(12)70323-x
- Major congenital malformations in children of women with epilepsy.Seizure. 2015; 28: 46-50https://doi.org/10.1016/j.seizure.2015.02.019
- Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency.Neurology. 2008; 70: 2130-2136https://doi.org/10.1212/01.wnl.0000289511.20864.2a
- The impact of pregnancy and childbirth on the metabolism of lamotrigine.Neurology. 2004;27;62(2):292–5.; https://doi.org/10.1212/01.wnl.0000103286.47129.f8
- Pharmacokinetics and therapeutic drug monitoring of newer antiepileptic drugs during pregnancy and the puerperium.Clin Pharmacokinet. 2007; 46: 209-219https://doi.org/10.2165/00003088-200746030-00002
- Oxcarbazepine concentrations during pregnancy: a retrospective study in patients with epilepsy.Neurology. 2006;24;67(8):1497–9.; https://doi.org/10.1212/01.wnl.0000240047.11166.0e
- Seizure frequency in pregnant women treated with lamotrigine monotherapy.Epilepsia. 2009; 50: 2163-2166https://doi.org/10.1111/j.1528-1167.2009.02166.x
- Antiepileptic drug clearances during pregnancy and clinical implications for women with epilepsy.Neurology. 2018; 91: e1228-e1236https://doi.org/10.1212/WNL.0000000000006240
- Seizure deterioration in women treated with oxcarbazepine during pregnancy.Epilepsy Res. 2009; 84: 245-249https://doi.org/10.1016/j.eplepsyres.2009.01.011
- Drug monitoring of lamotrigine and oxcarbazepine combination during pregnancy.Epilepsia. 2010; 51: 2500-2502https://doi.org/10.1111/j.1528-1167.2010.02771.x
Article info
Publication history
Published online: May 25, 2023
Accepted:
May 5,
2023
Received in revised form:
April 29,
2023
Received:
March 25,
2023
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
