No abstract

SUMMARYWe aimed to characterize the seizure pattern during pregnancy in a large cohort of women with epilepsy (WWE) and identify possible predictors of seizure relapse during pregnancy. We recorded the antiepileptic drug (AED) use and seizure frequency for WWE during the prepregnancy month and pregnancy. The seizure profile was correlated with the clinical details and seizure type as abstracted from the clinical records maintained in the registry. Of the 1,297 pregnancies in WWE with complete seizure data, 47.8% were seizurefree during pregnancy. Seizure relapse was highest during the three peripartum days. Women with partial seizures-had higher risk of relapse (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0) than those with generalized seizures. They had two peaks of seizure relapse (second to third month and sixth month). Those with generalized seizures had one peak at first trimester. Those who were on polytherapy had increased risk of seizures (OR 2.98, 95% CI 2.3-3.9) when compared to those on monotherapy. Those who had seizures in the prepregnancy month had higher risk (OR 15, 95% CI 9-25.1) of seizures during pregnancy when compared to those who were seizure-free during that period. On multiple logistic regression, prepregnancy seizure was the most important predictor of seizures during pregnancy. KEY WORDS: Epilepsy, Pregnancy, Seizure predictors, Fetal outcome.One of the main concerns for women with epilepsy (WWE) is how seizures would behave during pregnancy. According to a large pregnancy registry, nearly 60% of WWE remained seizure-free during pregnancy (EURAP, 2006). The seizure pattern during pregnancy may be influenced by variations in ovarian hormones, blood levels of antiepileptic drugs (AEDs), and metabolic changes. The objective of this study was to characterize the seizure outcome of a large cohort of WWE who were prospectively followed up under the Kerala Registry of Epilepsy and Pregnancy (KREP). MethodsWWE who gave informed written consent, are enrolled in KREP in the preconception stage or first trimester. They were followed up with three clinic visits during pregnancy (6)(7)(8) 18, and 24-28 weeks) (Thomas et al., 2001; Beghi et al., 2001). (See Data S1 for details of the registry and methodology of this study.) Maternal seizures were classified as partial with or without secondary generalized or generalized (without a partial onset by semiology or electroencephalography [EEG]). The monthly seizure count included both partial and generalized seizures. The AED use and seizure count were ascertained by recall for the preconception period and by seizure diary and pregnancy calendar after notification of pregnancy. Peripartum period refers to the day of delivery or 1 day before or after delivery. We did not do therapeutic drug monitoring or modify AED therapy during pregnancy unless women had unexpected seizure aggravation or adverse effects. The institutional ethics committee had approved this study. We analyzed the maternal seizure type, AED use, and seizure count for the prepr...

Among the residents of Kerala, most epilepsy is not related to cysticercosis.

Purpose:To study the epileptiform discharges (EDs) in the electroencephalogram (EEG) of 6-8-year-old children of women with epilepsy (WWE).Materials and Methods:All children born to women with epilepsy and prospectively followed up through the Kerala Registry of Epilepsy and Pregnancy (KREP), aged 6–8 years, were invited (n = 532). Out of the 254 children who responded, clinical evaluations and a 30-min digital 18 channel EEG were completed in 185 children.Results:Of the 185 children examined, 37 (20%) children (19 males, 18 females) had ED in their EEG. The EDs were generalized in 7 children, and focal in 30 children. The EDs were present in the sleep record only of 16 (43%) children and in the awake record only of 6 (16%) children. Out of the 94 children for whom seizure history was available, 7 children (7.4%) had seizures (neonatal seizures: 4, febrile seizure: 1, and single nonfebrile seizure: 2) and none had history of epilepsy or recurrent nonfebrile seizures. The odds ratio (OR) for occurrence of ED in the EEG was significantly higher for children of WWE [OR = 3.5, 95% confidence interval (CI) 2.3-6.0] when compared to the published data for age-matched children of mothers without epilepsy. There was no association between the occurrence of ED and the children's maternal characteristics [epilepsy syndrome, seizures during pregnancy, maternal intelligence quotient (IQ)] or the children's characteristics [antenatal exposure to specific antiepileptic drugs (AEDs), birth weight, malformations, IQ].Conclusion:Children of WWE have a higher risk of epileptiform activity in their EEG when compared to healthy children in the community though none had recurrent seizures.