Predicting epileptic seizure control during pregnancy.

Area of Science:

• Neurology
• Obstetrics
• Pharmacology

Background:

• Epilepsy affects pregnant women, necessitating careful management of seizure disorders and antiepileptic drug (AED) use.
• Predicting seizure control during pregnancy is crucial for maternal and fetal well-being.

Purpose of the Study:

• To determine if pre-pregnancy seizure activity, epilepsy type, and early pregnancy antiepileptic drug (AED) use predict seizure freedom during pregnancy.
• To assess the relationship between pre-pregnancy seizure control and seizure occurrence in pregnant women with epilepsy.

Main Methods:

• Analysis of data from the Australian Pregnancy Register (APR) (1998-2016).
• Inclusion of 1939 pregnancies after exclusions for loss to follow-up and premature termination.
• Statistical analysis using relative risk (R.R.) calculations to assess seizure occurrence and AED therapy.

Main Results:

• 42.8% of pregnancies involved seizures, with 19.9% experiencing convulsive seizures.
• Active epilepsy in the pre-pregnancy year was associated with a 78.4% seizure occurrence rate during pregnancy.
• Pregnancies with no AEDs in early pregnancy had a 54.9% seizure occurrence rate, compared to 45.5% with continuous AED treatment.

Conclusions:

• Women with epilepsy (WWE) with active seizures pre-pregnancy are 3-4 times more likely to have seizures during pregnancy.
• Lack of antiepileptic drug (AED) use in early pregnancy significantly increases seizure risk during gestation.
• Maintaining seizure control prior to and during pregnancy is vital for improving seizure-free outcomes in women with epilepsy.