Abstracts

Pregnancy in women with epilepsy presents with multiple issues that are not encountered in the general population, notably increase risk of seizures, maternal complications, and higher risk of adverse fetal outcome. Much is known about changes in plasma levels in highly protein bound agents during pregnancy, increase in seizure frequency in pregnancy, as well as the risk of teratogenicity related to the older [ldquo]standard [ldquo]anticonvulsants. Limited information regarding teratogenicity is available about the [ldquo]newer[rdquo] agents in pregnancy. Over the last eight months, 17 pregnant women with epilepsy presented for consultation to the epilepsy clinic. Two women became pregnant twice during this time frame. Each patient was followed by a neurologist during the pregnancy. Attempts were made to collect plasma levels of anticonvulsant medication on a monthly basis,and adjusted according to either drop in level or increase in seizure frequency. When possible, plasma levels are collected from cord blood. Levels are also collected in the immediate postpartum . Of the 19 pregnancies, there have been to date 10 live births, 2 miscarriages. 15 women are on monotherapy,10 of which are on newer agents and 4 on polypharmacy.
7 of 8 women to date continued to experience seizures during pregnancy, 2 with an increase in seizures. To date, one patient has had a breakthrough seizure during pregnancy .
All women have shown alterations in plasma levels and in most, an increase in dosage was necessary.
The 10 live births had normal fetal outcomes. One patient developed lateral sinus thrombosis during pregnancy. Data pertaining to the remaining pregnancies as well as any future consultations are being collected. Monitoring of both seizure frequency and plasma levels are indicated in pregnancy. Information about the newer agents their effects in pregnancy. Is the efficacy of the newer agents during pregnancy better, is teratogenicity less, is there variation in plasma levels during pregnancy between the protein bound and renally excreted drugs. This cohort of women is too small to answer any of these questions, yet may serve as a stepping stone. Outcome pregnancy data are important as they may or may not lead to changes in the future treatment of women with epilepsy of childbearing potential .