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Address correspondence and reprint requests to Dr. Torbjörn Tomson, Department of Neurology, Karolinska University Hospital, SE 17176 Stockholm, Sweden; e-mail: torbjorn.tomson{at}karolinska.se
Objective: To analyze seizure control and treatment in pregnant women with epilepsy.
Methods: Seizure control and treatment were recorded prospectively in 1,956 pregnancies of 1,882 women with epilepsy participating in EURAP, an international antiepileptic drugs (AEDs) and pregnancy registry.
Results: Of all cases, 58.3% were seizure-free throughout pregnancy. Occurrence of any seizures was associated with localization-related epilepsy (OR: 2.5; 1.7 to 3.9) and polytherapy (OR: 9.0; 5.6 to 14.8) and for tonic-clonic seizures, with oxcarbazepine monotherapy (OR: 5.4; 1.6 to 17.1). Using first trimester as reference, seizure control remained unchanged throughout pregnancy in 63.6%, 92.7% of whom were seizure-free during the entire pregnancy. For those with a change in seizure frequency, 17.3% had an increase and 15.9% a decrease. Seizures occurred during delivery in 60 pregnancies (3.5%), more commonly in women with seizures during pregnancy (OR: 4.8; 2.3 to 10.0). There were 36 cases of status epilepticus (12 convulsive), which resulted in stillbirth in one case but no cases of miscarriage or maternal mortality. AED treatment remained unchanged in 62.7% of the pregnancies. The number or dosage of AEDs were more often increased in pregnancies with seizures (OR: 3.6; 2.8 to 4.7) and with monotherapy with lamotrigine (OR: 3.8; 2.1 to 6.9) or oxcarbazepine (OR: 3.7; 1.1 to 12.9).
Conclusions: The majority of patients with epilepsy maintain seizure control during pregnancy. The apparently higher risk of seizures among women treated with oxcarbazepine and the more frequent increases in drug load in the oxcarbazepine and lamotrigine cohorts prompts further studies on relationships with pharmacokinetic changes. Risks associated with status epilepticus appear to be lower than previously reported.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the February 14 issue to find the title link for this article.
This article was previously published in electronic format as an Expedited E-Pub on December 28, 2005, atwww.neurology.org.
*The complete list of collaborators is given in appendix E-1 on the Neurology Web site at www.neurology.org.
EURAP receives financial support from the following pharmaceutical companies: GlaxoSmithKline, Janssen-Cilag, Novartis, Pfizer, Sanofi-Aventis, and UCB Pharma.
Dr. Craig has received honoraria from UCB Pharma, GlaxoSmithKline, Sanofi-Synthelabo, Janssen-Cilag, and Pfizer for lectures and has received sponsorship from UCB-Pharma, GlaxoSmithKline, Janssen-Cilag, and Sanofi-Synthelabo to attend conferences. Dr. Perucca has received speaker's or consultancy fees and/or research grants from Novartis, Pfizer, GlaxoSmithKline, UCB Pharma, Sanofi-Aventis, and Janssen-Cilag/Johnson and Johnson. Fees and grants from UCB Pharma and Janssen-Cilag/Johnson and Johnson exceeded $10,000 USD/year. Dr. Sabers has received honoraria from GlaxoSmithKline, Novartis, and UCB Pharma. Dr. Tomson has received honoraria from Pfizer and Sanofi-Aventis and owns 100 shares in Pfizer. Dr. Vajda has received honoraria and consultancy fees from Sanofi-Synthelabo, UCB-Pharma, and GlaxoSmithKline. Drs. Battino, Bonizzoni, and Lindhout have nothing to disclose.
Received June 30, 2005. Accepted in final form October 24, 2005.
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