Post-pregnancy changes in seizure frequency and antiseizure medication treatment

Maternal seizures during the post-pregnancy period are associated with severe morbidity and increased risk of mortality, and pose a risk of injury to their babies, that may be sometimes life threatening.

To evaluate whether seizure frequency during post-pregnancy is higher compared to the pre-pregnancy period and to nonpregnant women with epilepsy.

We retrospectively reviewed the computerized database and the medical records of all the women with epilepsy who were followed-up in our adult epilepsy clinic during an 8-year period (2012-2020), and identified 42 pregnancies in 34 women. The control group included 42 nonpregnant women with epilepsy, matched for age and epilepsy type.

Mean monthly seizure frequency, seizure freedom rates and changes of seizure frequency during pregnancy and post-pregnancy did not significantly differ between pregnant women and controls. Among pregnant women there was a trend towards decreased seizure frequency during post-pregnancy (p = 0.076). Pregnant women received fewer antiseizure medications (ASMs) during pregnancy (1.3 vs 2) (p = 0.004) and post-pregnancy (1.4 vs 1.9) (p = 0.023) compared to controls, with a trend towards fewer ASMs during pre-pregnancy (p = 0.051). Compared to controls, changes of ASM treatment were more common in pregnant women during post-pregnancy (57.1 % vs 33.3 %) (p = 0.048), with a trend towards more common ASM changes during pregnancy (p = 0.073).

Seizure frequency during post-pregnancy in women with epilepsy who are managed according to the guidelines did not significantly differ in this cohort from that during pre-pregnancy and during the same epoch in nonpregnant women with epilepsy.