Abstracts

Pregnancy registries are increasingly established to correlate malformation rate with use of AEDs in women with epilepsy. Other seizure and AED related problems remain unanswered in the treatment of epileptic pregnant women. Seizures during pregnancy are assumed to be detrimental, but significantly increased adverse outcomes have not been systematically studied., Retrospective review of 35 pregnancies that were followed in a highly specialized pregnancy and seizure clinic in an academic institution. Seizure occurrence, complication rate, abortion rate, malformation rate, preconceptive counseling and AED adjustments and levels were recorded during pregnancy., Of 35 pregnancies in 34 women, there were 22 deliveries, one first-trimester abortion and one 20-week abortion due to severe neural tube defect in a pregnancy on lamotrigine monotherapy (LTG). 11 women have not delivered yet. There were 2/35 (5.7 %) true malformations (neural tube defect, craniosynostosis) and 11/33 viable pregnancies were complicated by other than seizures (oliohydramion/low birth weight in three, rash due to AEDs in three, HELLP syndrome, bleeding, severe migraines, prematurity).
23 of 35 (65%) of all and 14 of 22 (63%) of completed pregnancies were complicated by seizures. This reflects the specialized referral pattern. Seizure occurred equally in the first, second or third trimester (p[gt]0.05). Of the six pregnancies with malformations, prematurity or low birth weight, four had seizures during pregnancy, two had generalized tonic-clonic convulsions (GTC). Overall 7/35 (20%) pregnancies were complicated by GTCs with two off-spring related complications (low-birth weight and neural tube defect). Only one patient had seizures during delivery (4.5%). Three previously well controlled patients had reoccurrence of myoclonic seizures when switched to lamotrigine monotherapy prepregnancy.
In 17/35 (48.5%) of pregnancies, AEDs needed to be changed either due to seizure exacerbation, side effects or decreasing levels. LTG (n=10) required regular adjustment of dosing due to decreasing levels, carbamazepine, valproic acid, phenytoin, levetiracetam and topiramate levels were more stable. Data on oxcarbazepine was insufficient. Three patients had their first seizure during pregnancy and all of those patients were not treated with AEDs.
12 (34.2%) of patients underwent prepregnancy counseling., Management of seizures during pregnancy remains challenging. The impact of seizures in pregnancies with or without AEDs needs to be studied in larger studies. Systematic investigation of AED adjustments during pregnancy is required to assess utility. Myoclonic epilepsies treated with LTG alone can be problematic in pregnancy. Specialized clinics can increase preconceptive intervention and improve AED management.,