Changes in seizure frequency and anti-seizure medication therapy during pregnancy and one year postpregnancy

• Published in: Epilepsy & behavior 2023-07, Vol.144, p.109256-109256, Article 109256
• Main Authors: Du, Yanru, Fang, Wenqiang, Huang, Wenting, Xu, Qi, Gong, Jiaoni, Xia, Niange, Zhu, Zhenguo, Wang, Xinshi, Zheng, Rongyuan, Xu, Huiqin
• Format: Article
• Language: English
• Subjects: Anti-seizure medication; Epilepsy; Pregnancy; Seizure frequency
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2023.109256

•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. 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.