Change of seizure frequency in pregnant epileptic women.

Abstract

SUMMARY The effect of pregnancy on seizure frequency was monitored prospectively in 136 pregnancies of 122 epileptic women. Pregnancy did not influence the seizure frequency in 68 pregnancies (50%). In 50 pregnancies (37%) the number of seizures increased during pregnancy or puerperium. The seizure frequency decreased in 18 pregnancies (13%). In 34 out of 50 pregnancies (68%) the increase was associated with non-compliance with the drug regimen or sleep deprivation. In seven out of 18 pregnancies (39%) improvement was related to correction of non-compliance or sleep deprivation during the pregestational nine months. Insufficiently low plasma concentrations of antiepileptic drugs were found in 47% of the women with uncontrolled epilepsy during pregnancy. The course of epilepsy during pregnancy is primarily influenced by non-compliance, sleep deprivation during pregnancy, and inadequate therapy before and during pregnancy. With good medical attention pregnancy itself seems to have only a minimal influence on the course of epilepsy.Improvements in the drug therapy of epilepsy have led to a growing number of well controlled epileptic women in childbearing age. It is therefore not surprising that the influence of pregnancy on the course of epilepsy has received renewed interest. According to a recent review, the seizure frequency improved in 23% and deteriorated in another 24% of 2165 pregnancies.' A number of variables may influence the seizure frequency. These include hormonal and metabolic factors, respiratory changes, psychological problems, non-compliance with the prescribed drugs regimen, changes in pharmocokinetics of antiepileptic drugs, and a modification of seizure propensity during pregnancy.' Preliminary studies suggested that non-compliance, seizure provocation, and a decrease in the plasma concentration of antiepileptic drugs may be primarily involved in the regulation of seizure frequency during pregnancy.23 Changes in seizure propensity can be studied directly in pregnant women not receiving antiepileptic drugs. The purpose of this prospective two-centre study of 136 pregnancies was to investigate changes in seizure frequency during pregnancy and to analyse clinical and pharmacological factors associated with a seizure relapse in the individual patient. Patients and MethodsA total of 136 pregnancies of 122 epileptic women were followed prospectively from 1977 to 1981 in West-Berlin, Germany and Milan, Italy. Pregnant women were excluded from the study if they had a total of less than three verified epileptic seizures, the data on the seizure frequency were incomplete or the pregnancy was ended by abortion. The patients were referred to the Epilepsy Clinic in Milan and Berlin from departments of gynaecology and neurology and gynaecologists and neurologists for pregnancy planning and during early pregnancy.23 The project was made known to them by regular distribution of information in letters and reprints. The patients were evaluated neurologically and usually seen at monthly intervals, when the history...

Lamotrigine in pregnancy

“…16 Observations of pregnant women with epilepsy taking a variety of AEDs indicate that approximately 17% to 37% of patients will have an increase in their seizures, 7% to 25% will have a decrease in seizures, and 50% to 83% will experience no significant change. 21,24 Most of these investigations have implicated subtherapeutic AED concentrations as a contributor to increased seizures during pregnancy. 16,[22][23][24] Generalized tonic-clonic seizures (GTC-Szs) are considered the most dangerous [25][26][27][28][29] and may even increase the risk for cognitive dysfunction in the offspring.…”

“…21,24 Most of these investigations have implicated subtherapeutic AED concentrations as a contributor to increased seizures during pregnancy. 16,[22][23][24] Generalized tonic-clonic seizures (GTC-Szs) are considered the most dangerous [25][26][27][28][29] and may even increase the risk for cognitive dysfunction in the offspring. 30,31 The alterations in LTG Cl during pregnancy have important clinical relevance.…”

The peculiarities of focal epilepsy in pregnant women

“…В литературе также приводят данные, согласно которым ухудшение течения эпилепсии в период беременности было связано с нарушением комплайентности к терапии или депривацией сна [7,10,11]. Правильная подготовка женщины к пред-стоящей беременности, хороший контроль пациенток, отсутствие припадков, по край-ней мере, за 3 мес до беременности, достиг-нутые коррекцией неадекватной терапии до беременности, недостаточной комплай-ентности и депривации сна, способствуют уменьшению частоты припадков во время беременности [12,13].…”

“…В то же время в некоторых случаях не-возможно объяснить причину улучшения течения эпилепсии при беременности, и оно может быть связано со случайной флюктуа-цией частоты припадков или другими фак-торами (например, гормональными измене-ниями) [11]. У 1 (1,4±1,4%) женщины после внезапно-го прекращения приема АЭП (карбамазепи-на) во время беременности зарегистрирован генерализованный судорожный эпилепти-ческий статус на 14-15-й неделях.…”

Late-Onset Rasmussen’s Syndrome with First Seizure during Pregnancy

“…Since oestrogens are known to be epileptogenic [7], pregnancy could reduce seizure threshold in a patient already harbouring a chronic, sub-clinical encephalitic pro cess. However, in patients with established epilepsy pregnancy does not have a consistent effect on seizure control, but if worsening does occur, this is most likely in the first trimester [8], Alternatively, the depression of cell-mediated immunity in pregnancy could facilitate primary viral infection or reactivation of latent infection with cyto megalovirus [6] or Epstein-Barr virus [9], both of which have been implicated in the encephalitic process underlying Rasmussen's syn drome. Moreover, it has been reported that alpha interferon, an agent with both immunomodulatory and antiviral activities, may improve both the seizure frequency and neurological deficit in Rasmussen's syndrome [10].…”