NEW ORLEANS – In a new finding, 53 percent of women with frontal lobe epilepsy, in which the seizures begin in the front of the brain, experience more frequent seizures during pregnancy, suggests a study being presented at the American Epilepsy
Society Annual Meeting.
The study also confirmed previous research that found women with focal epilepsy (in which seizures begin in one area of the brain) were more likely to experience more frequent seizures during pregnancy than those with generalized epilepsy (in which seizures
affect both sides of the brain). The new study found that those with the frontal lobe type of focal epilepsy were especially likely to experience more frequent seizures while pregnant. Researchers also noticed that although women with focal epilepsy
do worse during pregnancy when compared with women with generalized epilepsy, they tend to do better during the postpartum period. However, this finding did not reach statistical significance.
"Physicians need to monitor women with focal epilepsy – especially frontal lobe epilepsy – more closely during pregnancy because maintaining seizure control is particularly challenging for them," said Paula E. Voinescu, M.D., Ph.D., lead author
of the study and a neurologist at Brigham and Women's Hospital, Boston. "As we know from other research, seizures during pregnancy can increase the risk of distress and neurodevelopmental delays for the baby, as well as the risk of miscarriage."
The study included 114 pregnancies (99 women) and researchers analyzed seizure frequency during three periods: the nine months before pregnancy, during pregnancy and the nine months after birth (postpartum). They found:
- Seizures were more frequent during pregnancy compared to the pre-pregnancy period in:
- 5.5 percent of women with generalized epilepsy
- 22.6 percent of women with focal epilepsies
- 53 percent of women with frontal lobe epilepsy
- Seizures were more frequent during the postpartum compared to the pre-pregnancy period in:
- 12.12 percent of women with generalized epilepsy
- 7.14 percent of women with focal epilepsies
- 20 percent of women with frontal lobe epilepsy
The researchers also found that increased seizure activity tended to occur among women on more than one anti-epileptic drug (AED). In women with frontal epilepsy, seizure worsening was most likely to begin in the second trimester of pregnancy.
"Frontal lobe epilepsy is known to be difficult to manage in general and often resistant to therapy, but it isn't clear why the seizures got worse among pregnant women because the level of medication in their blood was considered adequate," said Dr. Voinescu.
"Until more research provides treatment guidance, doctors should carefully monitor their pregnant patients who have focal epilepsy to see if their seizures increase despite adequate blood levels and then adjust their medication if necessary."