Outcomes of pregnant women with refractory epilepsy

• Published in: Seizure (London, England) Vol. 69; pp. 251 - 257
• Main Authors: Kusznir Vitturi, Bruno, Barreto Cabral, Fábio, Mella Cukiert, Cristine
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2019
• Subjects: Adult; Anticonvulsants - therapeutic use; Antiepileptic drugs; Brazil; Comorbidity; Drug resistant epilepsy; Drug Resistant Epilepsy - complications; Drug Resistant Epilepsy - epidemiology; Drug Resistant Epilepsy - therapy; Epilepsy; Female; Follow-Up Studies; Humans; Longitudinal Studies; Medication Adherence; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Complications - therapy; Pregnancy Outcome; Prospective Studies; Risk Factors; Seizures; Seizures - epidemiology; Seizures - therapy; Treatment Outcome; Young Adult; Brazil; Pregnancy; Antiepileptic drugs; Epilepsy; Drug resistant epilepsy; Seizures
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2019.05.009

•A significant number of women with drug-resistant epilepsy did not achieve seizure control in pregnancy.•Most of patients required treatment changes during pregnancy, in dose and/or in number of antiepileptic drugs.•Increase in seizure frequency was associated with poor adherence, status epilepticus, increased dose and adding another antiepileptic drug.•Obstetrical complications were associated with polytherapy, multiple comorbidities, poor adherence and seizure deterioration. Epilepsy is the most common neurological disorder requiring medical treatment during pregnancy. However, very few studies are specially dedicated to pregnant women with refractory epilepsy. This study was carried out with the aim of describing obstetrical and neurological outcomes of pregnant women with refractory epilepsy in Brazil. Pregnant women with refractory epilepsy were enrolled in longitudinal cohort study between January 2005 and January 2018. They were regularly followed by a neurologist until the end of pregnancy. Neurological outcomes included seizure control, status epilepticus and adherence to antiepileptic medications. Obstetrical outcomes included major congenital malformations and obstetrical complications. A total of eighty two patients with a mean age of 24.5 ± 5.5 were included in our study. A significant number of women experienced an increase in seizure frequency and the prevalence of status epilepticus was 8.5%. More than half were non-adherent to antiepileptic drugs. Most of patients required treatment changes during pregnancy, in dose and/or in number of antiepileptic drugs. Cesarean section was the preferred way of delivery and five cases of major congenital malformations were detected. Obstetrical complications were significantly associated with polytherapy, multiple comorbidities, poor adherence to treatment and seizure deterioration during pregnancy (p < 0.05). Women with refractory epilepsy can have a significant risk of obstetric and neurological complications during pregnancy. Treatment of refractory epilepsy in pregnancy is a real challenge for neurologists.