Abstracts

RATIONALE: There is a complex interaction between epilepsy and pregnancy. Seizures tend to aggravate during pregnancy in a third of women with epilepsy. The risk of congenital malformations in the fetus and obstetric complications are other concerns. This study attempts to describe the natural history of seizures during pregnancy among women with epilepsy. METHODS: One hundred and twentytwo women with epilepsy who were enrolled in the Kerala Registry of Epilepsy of Pregnancy were prospectively evaluated from pre conception period through pregnancy and three puerperal months for seizure frequency, AED and folate regimen, details of pregnancy, delivery and fetal outcome. RESULTS: Epilepsy was classified as Generalized in 44.6% and localization related in 50.5%. 71.3% were on monotherapy. All received folate. Their mean seizure frequency/month (MSF)during pregnancy and puerperium (0.37?2.45) remained lower than pre-pregnancy level (2.02?10.43) except for three peripartum days (3.3?0.7) which was 3-15 times more than adjacent months. Two patients had status epilepticus.The natural history of seizures during pregnancy could be classified in to four distinct patterns. There were 32 women with MSF unchanged (stable unchanged pattern), 23 with MSF less than pre-pregnancy period (stable improved pattern) 4 with MSF more than pre-pregnancy period (stable worse pattern) and 38 with MSF fluctuating from more to less or vice versa (unstable pattern). There was no statistically significant correlation between the AED used, type of epileptic syndrome, or fetal outcome and any specific seizure pattern.CONCLUSIONS: Seizure frequency tends to improve during pregnancy and peurperium in two thirds of women. There is an increased risk of seizures during the three peripartum days. Epilepsy may take one of the three stable patterns or an unstable pattern during pregnancy and puerperium.