Neurological Outcomes of Pregnant Patients with Epilepsy in a Canadian Tertiary Care Center (2014-2020)
Abstract number :
2.28
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2024
Submission ID :
1165
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Sharon Ng, BASc – Harvard University
Yajur Iyengar, BSc – University of Toronto
Sabrina Chan, BSc., Hons – University of Toronto/ University Health Network
John Snelgrove, MD – Mount Sinai Hospital
Julien Hébert, MD MSc – University of Toronto
Presenting Author: Esther Bui, MD – University of Toronto
Rationale: Limited data exists on neurological care and outcomes of Canadian pregnant patients with epilepsy (PPWE). This study provides Canadian data to inform current practice patterns and neurological outcomes for PPWE at a tertiary care center.
Methods: We retrospectively identified pregnancies by PPWE seen in an urban Canadian tertiary care center between January 1, 2014, and November 20, 2020. We reviewed the patients’ medical records to identify demographics, anti-seizure medication (ASM) use, and neurological outcomes pre-pregnancy and during pregnancy, labor, and delivery. This study was approved by the institution’s Review Ethics Board.
Results: A total of 195 pregnancies were identified, with a median maternal age of 32.8 years (SD 4.58) and a median age at first seizure of 17 years (range 1 month – 36 years old). Our cohort was predominantly highly educated, employed, and in stable relationships. Out of the 195 pregnancies, 50% were diagnosed with genetic generalized epilepsy and 50% endorsed 6 months of seizure freedom prior to conception. A majority (57%) of pregnancies had no seizure recurrence during pregnancy. Among those that did have gestational seizure recurrence (43%), 81% of them had stable seizure frequency. There were 181 (93%) pregnancies that had gestational ASM(s) use, with 70% of those pregnancies being on monotherapy and 30% being on polytherapy. Among those 181 pregnancies, therapeutic drug monitoring (TDM) was observed in 77% of pregnancies and ASM dose adjustments were reported in 69% of pregnancies. We observed an increase in ASM dose among 83% of pregnancies that had drug dose adjustments. An analysis of ASM prescribing patterns over time in this cohort showed a general decrease in the prescription of “older” ASMs such as topiramate, carbamazepine and valproate from 2016 to 2021, and a general increase in newer ASMs such as lamotrigine and levetiracetam. Logistic regression analysis shows that seizure freedom for 1 year or more before conception is associated with lower odds (0.045, 95% CI: 0.018-0.104, p < 0.001) of seizure recurrence during pregnancy compared to those who were not seizure-free, after adjusting for maternal age, seizure type, ASM mono/polytherapy use, and presence of TDM.
Clinical Epilepsy