According to study results published in the New England Journal of Medicine, changes in the dosage of anti-epileptic drugs were more common in pregnant women than in non-pregnant women with epilepsy.
This was a prospective, observational, parallel group study of women (N = 460) with epilepsy who were enrolled at 20 centers in the United States between 2012 and 2016. Women were stratified by pregnancy status and screened for seizures and epilepsy therapeutics. The study researchers defined epoch 1 as the pregnant and peripartum stage (6 weeks after birth) and epoch 2 as the postpartum stage (6 weeks to 9 months after birth). Women in the control group consisted of non-pregnant women with epilepsy. Pregnant women and women in the control group were assessed at the same number of visits.
A total of 351 women were pregnant and 109 were not. Pregnant and non-pregnant women with epilepsy were on average 31 and 30 years old, respectively. Additionally, 85% and 93% were white, 52% and 47% were seizure-free 9 months prior to study entry or pregnancy, and 77% and 81% were receiving monotherapy for their epilepsy.
Seizures were more common in epoch 1 in 23% of pregnant women and 25% of women in the control group (odds ratio) [OR]0.93; 95% CI, 0.54-1.60). During the first epoch, 29% of pregnant women and 31% of non-pregnant women reported at least one seizure affecting consciousness. During the second epoch, 26% and 15%, respectively, reported a consciousness-impairing seizure.
The mean number of seizures was normalized to a 28-day value and was higher during epoch 1 (pregnant, 0.69; control, 1.40) than in epoch 2 (pregnant, 0.55; control, 0.28) . For women who did not have a seizure in the nine months prior to the study, the study researchers found no significant difference between the groups.
For women who had a seizure during the study, 74% of pregnant women and 31% of non-pregnant women had modified epilepsy medication (OR, 6.36; 95% CI, 3.82-10.59). The dose of anti-epileptic drugs was increased in 70% of the pregnant women compared with 24% of the non-pregnant women (OR 7.49; 95% CI 4.37-12.84).
This study was limited due to its observational design, lack of data, and the inability to calculate differences between groups for certain types of underperformance seizures.
The study’s researchers concluded that while they did not find any significant differences between pregnant and non-pregnant women in terms of increased seizure frequency during epoch 1 compared to epoch 2, “changes in anti-epileptic drug doses in pregnant women over similar periods of time occurred more often than in non-pregnant women. ”
Disclosure: Several authors have declared their affiliations with the industry. For a full list of details, see the original article.
Pennell PB, French JA, May RC, et al. Changes in seizure frequency and anti-epileptic therapy during pregnancy. N Engl J Med. 2020; 383 (26): 2547- 2556. doi: 10.1056 / NEJMoa2008663