Neurology Today – LWW Journals

Neurology Today – LWW Journals

Women with focal epilepsy, particularly localized in the frontal lobe, are at a higher risk of experiencing more frequent seizures during pregnancy compared with women with generalized epilepsy, according to a study published online on December 10 in Neurology.

Pregnant women with frontal lobe epilepsy were at a higher risk for seizures, independent of polytherapy and preconception seizure status.

“Prior studies suggest that seizure frequency in the nine months prior to pregnancy is a good predictor of seizure frequency during pregnancy, though focal epilepsy syndromes and treatment with specific antiseizure medications (ASM) may be associated with a higher rates of seizure worsening during pregnancy,” explained lead study author P. Emanuela Voinescu, MD, PhD, a neurologist and epileptologist at Brigham and Women’s Hospital in Boston and an instructor at Harvard Medical School in Boston, and colleagues. “These studies did not incorporate analyses of localization, nor details about ASM concentrations.”

To determine if seizure frequency is influenced by epilepsy type, seizure location, and ASMs during pregnancy and postpartum, the study authors collected clinical data from 99 women with epilepsy contributing 114 pregnancies completed between 2011 and 2019 at Brigham and Women’s Hospital in Boston.

For each participant, the researchers calculated an average four-week seizure frequency for the nine preconception months to use as a “baseline.” They subsequently calculated seizure frequency for each four-week interval during pregnancy and six to nine months postpartum. If one or more of the four-week intervals exhibited an increase above the established baseline, the pregnancy was categorized as “increased seizure frequency.” The researchers also collected clinical data related to ASM dose adjustments, serum concentrations, seizure types and frequency, and pregnancy outcomes.

The study authors found that pregnant women with focal epilepsy experienced increased seizure frequency more than pregnant women with generalized epilepsy (21.1 percent versus 5.3 percent). They also found that 52.9 percent of the pregnant women with frontal lobe epilepsy experienced worsening seizures, compared with only 11.9 percent of the pregnant women with other focal epilepsies. The pregnant women with frontal lobe epilepsy tended to experience worse seizures, starting at 20-week gestational age and again late in the second trimester.

The seizures increased by more than 50 percent during pregnancy among women who experienced worsening seizures. Only one patient experienced a less than 50 percent increase.

The women on polytherapy had an eight-fold higher risk of seizure worsening than those on monotherapy, regardless of the type of epilepsy or medication. A lack of preconception seizure freedom was also associated with increased seizure frequency during pregnancy.

During the postpartum period, the researchers found no differences between focal and generalized epilepsy (11.1 percent versus 9.1 percent), or frontal and other focal (18.8 percent versus 6 percent) epilepsy groups.

The study authors concluded that larger studies will be needed to validate the findings and that any future studies should include measures of sleep, but despite its limitations, the study indicates a need for closer monitoring of pregnant patients with focal epilepsy and particularly frontal lobe epilepsy.

This study received funding from the National Institutes of Health, National
Institute of Neurological Disorders and Stroke, the Brigham Women’s Brain Initiative, the BIRCWH Associate Scholarship, and the Karger Foundation.

Dr. Voinescu received honoraria for lectures from Brainwork. Dr. Pennell reported grants from the National Institute of …….