Prospective, case–control study on the effect of pregnancy on seizure frequency in women with epilepsy

Abstract

To evaluate if pregnancy induces a change in seizure frequency and in percentage of subjects remaining seizure-free. This is a prospective case-control study conducted in our tertiary epilepsy centre. Controls were matched 2:1 with the cases for relevant clinical parameters. Cases had to be referred to our centre for at least 9 months before-pregnancy, during pregnancy and the-9-months-after-birth. Controls were followed for the correspondent periods of time: named respectively control period 1-2-3. Seizure frequency was defined as "improved" if there was a 50 % of reduction, "worsened" if there was a 50 % of increase, and "unchanged" in the rest of cases. We recruited 36 cases and 72 controls [in both group mean age was 28 years, partial epilepsy (80.6 %), generalized epilepsy (19.4 %)]; 30 cases and 60 controls were seizure-free before pregnancy and in period 1, respectively. During pregnancy 72 % of cases remained "unchanged" while 8 and 19 % respectively "improved" and "worsened"; moreover, there was no statistical difference in the number of seizure-free patients and in the monthly seizure frequencies. No differences were found in controls. In this prospective case-control study, pregnancy does not affect seizure frequency in women with epilepsy.

Delivery of a Personalized Treatment Approach to Women with Epilepsy

“…Most studies report that seizures are stable in over half of WWE during pregnancy, while other studies report that seizure worsening occurs in up to 75% of women during at least one time point during pregnancy. 32,33 The likelihood of seizure worsening depends on several factors: baseline seizure frequency (in the prior month or 9-12 months), seizure types (focal more likely to worsen than generalized-onset seizures), AEDs at beginning of pregnancy (LTG, OXC, polytherapy use are associated with higher risk for seizure worsening), use of therapeutic drug monitoring, and patient adherence.…”

Estrogen actions in the nervous system

“…Catamenial epilepsy may have its onset in puberty and may occur in the perimenstrual, periovulatory, or luteal phase; the most common form has a perimenstrual pattern, occurring between 3 days before and 3 days after menses. 106 In another study, a higher percentage of women with history of CE remained seizure-free during pregnancy compared to women with noncatamenial epilepsy. 103,112 The molecular pathophysiology of CE remains unclear; perimenstrual CE has been attributed to neurosteroid withdrawal, which is associated with upregulation of extrasynaptic GABA A receptors that mediate tonic inhibition in the dentate gyrus.…”

“…11,[103][104][105][106] Experimental studies indicate that, in general, estrogens have a proconvulsant effect whereas progesterone has anticonvulsant properties. There is clinical evidence that estrogens (and progesterone) may influence the predisposition to epilepsy.…”

Advances in clinical neurology through the journal “Neurological Sciences” (2015–2016)

“…Seizure outcome in patients with juvenile absence epilepsy is not clear [149], and cognitive deterioration is not rare [150]. A prospective case-control study has shown that pregnancy does not affect seizure frequency in women with epilepsy [151]. Psychogenic nonepileptic seizures are more frequent among women and have possible biological basis [152,153].…”