Abstracts

Rationale:
Of the 18 million women with epilepsy (WWE), approximately 40% are within child-bearing age (Chen, et al, 2009). Uncontrolled seizures can have serious implications on an unborn child including hypoxia, low birth weight, and cognitive delay (Sveberg, et al, 2015). However, seizures must be balanced with limiting fetal exposure to potential teratogenic side effects of antiepileptic drugs (AEDs). Treatment of medically refractory epilepsy (MRE) in pregnant WWE with vagus nerve stimulation (VNS) has been associated with increased obstetrical intervention but not teratogenic effects as per Sabers, et al (2017). Responsive neurostimulation (RNS) has been increasingly used as a neurostimulation option for MRE. RNS provides the additional advantage of real time electrocorticography (ECoG) monitoring of seizure activity, which could assist with more accurate seizure counts and titration of AEDs. We present the case of a young woman with MRE and RNS placement who was followed through the course of her pregnancy.  
Method:
A retrospective case review was performed, including medical records and electrocorticography (ECoG).  
Results:
JD is a 23year old female with history of a left fronto-parietal focal cortical dysplasia (FCD) and resultant epilepsy. She began having seizures at age 6 and underwent craniotomy and resection of the FCD at age 12. She continued to have refractory epilepsy despite multiple medication trials. She had a RNS device placed in September 2018 at age 22 with two strips– one anterior and one posterior to her prior resection site. Her device was titrated over the first 9 months with ~50% reduction in clinical seizure frequency. In July 2019, she presented to the clinic with increased seizure frequency, which was corroborated with increased long episodes (LE) seen on ECoG. She was discovered to be 8-9 weeks pregnant with subtherapeutic AED levels. Throughout her first and second trimester, her AEDs were optimized and RNS device continued to be titrated, as she continued to have increased seizures and concordant LE on ECoG. Early in her 3rd trimester, she had episodic dizziness with associated gait instability and falls and new seizure-like events. ECoG showed an overall decrease in LE and confirmed that her new seizure-like episodes did not have associated ictal EEG correlate. She was induced at 37 weeks gestation.  She gave birth to female infant, small for gestational age. The newborn was briefly hospitalized in the neonatal intensive care unit and has no other known congenital malformations to date.
Conclusion:
We report a case of a pregnant WWE and RNS. Her device was titrated throughout her first two trimesters with no apparent adverse effect to patient or the newborn. Real-time ECoG was also beneficial in monitoring seizure frequency, assessing new events, and aided AED titration throughout her pregnancy. Further investigation is needed to assess additional risks, benefits, and safety of RNS in pregnancy.
Funding:
:None