Neuromodulation and Antiseizure Medications During Pregnancy: Safety Profile and Treatment Outcomes from a Retrospective Observational Study
Abstract number :
2.281
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2024
Submission ID :
927
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Isha Snehal, MD – University of Nebraska Medical Center
Yashwanth Pulluru, MD – University of Nebraska Medical Center
Xiaohan Peng, MBBS – University of Nebraska Medical Center
Monica Bentzinger, RN, BSN – Nebraska Medicine Hospital
Lakshman Arcot Jayagopal, MD – University of Nebraska Medical Center
Rationale: Managing epilepsy during pregnancy can be challenging. Due to the changes in physiology during pregnancy, the pharmacokinetics of antiseizure medications are altered. Additionally, while there is existing data regarding antiseizure medications and their effects on pregnancy, there is a paucity of data regarding neuromodulation, pregnancy and neonatal outcomes
Methods: This is a retrospective observational study where electronic medical records of female patients with epilepsy who delivered between November 2022 to April 2024 were reviewed. Data regarding the epilepsy diagnosis, anti-seizure medications during pregnancy, neuromodulation treatment, pregnancy and neonatal outcomes were extracted. Appropriate statistical methods were used to analyze the data.
Results: 52 patients were included in this study with 56 pregnancies. The mean age of diagnosis of epilepsy was 16.4 ± 6.9 years. The mean age of pregnancy was 30.5± 4.8 years. A majority 53.5% were on monotherapy, 21.4% were on 2 and 17.8% on 3 ASMs, 5.3% on 4 and 1.7% on 5 ASMs. Most used ASMs were levetiracetam and lamotrigine with 35 (62.5%) and 23 (41%) on them respectively. 27 (48.2%) of patients had complications during pregnancy, miscarriage being the most common (4). 11(19.6%) of these pregnancies were characterized by adverse neonatal outcomes including NICU admission (3), preterm birth (4), small for gestational age (2), fetal macrosomia (1), fetal malpresentation (1), fetal hydronephrosis (1).
12/56 (21.4%) were treated with neuromodulation and antiseizure medications, 2 had a responsive neurostimulation device (RNS) and 10 had a vagus nerve stimulation device (VNS).
For one of the patients, VNS was turned off due to excessive cough. Among those with neuromodulation, 6 (50%) had complications during pregnancy. 10 (83.3%) of those on neuromodulation had good neonatal outcomes. There were no major congenital malformations (MCM’s) identified.
Conclusions: In this small retrospective study, no MCMs were identified in patients treated with anti-seizure medications alone or a combination of ASMs and neuromodulation. The pregnancy complications observed are consistent with what has been described in prior studies and no difference was noted in neuromodulation group.
Funding: There was no funding received in support of this abstract
Clinical Epilepsy