Authors :
Presenting Author: Hyunseo Kim, BA – Brigham and Women's Hospital
Thomas McElrath, MD, PhD – Brigham and Women's Hospital
Page Pennell, MD – University of Pittsburgh
Regan Lemley, MD, MS – Brigham and Women's Hospital
Sydney Hopkins, MPH – Brigham and Women's Hospital
Deepa Punnoose, PA-C – Brigham and Women's Hospital
Paula Voinescu, MD, PhD – Brigham and Women’s Hospital, Mass General Brigham, Harvard Medical School
Rationale:
Lacosamide (LCM) is a newer antiseizure medication that has been increasingly prescribed for seizure control, including in people of gestational potential. However, the potential effects of LCM exposure during pregnancy are not well-characterized. This study aims to characterize maternal and fetal outcomes in pregnancies treated with LCM.
Methods:
We conducted a retrospective chart review of pregnancies managed at Brigham and Women’s Hospital from 2016-2025 treated with LCM. Data extracted from electronic health records include epilepsy and seizure types, seizure frequency, medication dosage, details on delivery and breastfeeding, and congenital malformations. Both ongoing and completed pregnancies were included in the analysis.
Results:
Twenty-one patients, contributing 27 pregnancies, were identified as having exposure to LCM at some point during pregnancy: 25 had exposure throughout, 1 started LCM in the second trimester, and 1 in the third. LCM monotherapy was used in 9 pregnancies, while LCM polytherapy—most often with levetiracetam (66.7%)—was used in 18. Side effects on LCM were reported in five pregnancies, including shakiness, dizziness, increased fatigue, and decreased mental acuity. Mean total daily dose at conception was 353.70 mg (SD=157.46) and 515.91 mg (SD=216.24) at delivery.
Mean age at delivery was 32.11 years (SD=5.12). Two of 21 patients (9.52%) had generalized epilepsy, 18 (85.71%) had focal epilepsy and one patient’s epilepsy type was unknown. Compared to 9-12 months preconception, seizures remained stable in frequency and intensity in 8 pregnancies, improved in 10, and worsened in 7 pregnancies. For two, preconception seizure data was not available. Data was included up to the most recent time point available, with 6 pregnancies either in the immediate postpartum period or currently ongoing and expected to deliver within the next two months. Among pregnancies with available data through 6-12 months postpartum, 7 showed seizure worsening and 6 showed improvement during the postpartum period compared to the preconception baseline.
Of 27 pregnancies, 13 (48.15%) were primipara, while 14 (51.85%) were multipara. Of 22 completed pregnancies, 5 (22.73%) were delivered via C-section, and 17 (77.27%) were vaginal deliveries. There were five preterm deliveries before 37 weeks of gestation, and no miscarriages or stillbirths. Congenital malformations were reported in 2 pregnancies (7.41%). One involved a mild toe anomaly (polytherapy with levetiracetam), while the other presented with multifocal vascular and lymphatic malformations suspicious for Klippel-Trénaunay syndrome, a genetic syndrome (dual therapy in early pregnancy with topiramate).
Conclusions:
Lacosamide was generally well-tolerated during pregnancy, with all pregnancies resulting in live births and a low rate of negative maternal or fetal complications. Future analysis will examine serum concentrations, fetal birthweight, APGAR scores, postpartum mental health, and neurodevelopmental outcomes.
Funding:
This work was supported by an AmeriCorps grant, which funded the presenting author's research time, and the Karger Fund, which supported conference-related expenses.