Abstracts

Nocturnal Frontal Lobe Epilepsy (NFLE) is established as a distinct clinical epileptic syndrome with a spectrum of clinical presentations within the heterogeneous group of paroxysmal sleep-related disturbances. Pregnancy is well known to exacerbate seizures in many patients with epilepsy, but there are no reports of the effects of pregnancy on seizures in patients with NLFE., We report two women with NFLE documented by clinical history and video-EEG monitoring with severe seizure exacerbations during pregnancy. Both patients had long histories of mainly nocturnal episodes of motor jerking or spasm involving mainly the hand and arm on one side and nocturnal generalized tonic-clonic seizures. Both patients were eventually successfully treated with carbamazepine with nearly complete resolution of symptoms. However, during their first pregnancies both patients experienced severe exacerbations of their nocturnal seizures requiring hospitalizations. Additionally, both patients were on high doses of folic acid., An exacerbation occurred in the 3^rd trimester of pregnancy in one patient taking stable doses of Carbatrol, with therapeutic carbamazepine blood levels, despite increasing the dosage of Carbatrol. During the exacerbation she experienced several distressing nocturnal seizures. Upon admission to the hospital her seizures were eventually controlled upon substitution with a short acting carbamazepine preparation, given more frequently than her Carbatrol, and the addition of phenytoin. Events subsequently improved and she was tapered from phenytoin and maintained on the short acting carbamazepine with therapeutic blood levels. She delivered a healthy child without complication, after which she resumed taking Carbatrol without problems. The second patient took carbamazepine only at bedtime with therapeutic blood levels, when her seizures suddenly severely worsened in the first trimester of her pregnancy, despite modest increases in the dosages. She was admitted to the hospital and the dosage was increased and spread out and her folic acid dosage was reduced. Her episodes ceased and she eventually was able to return to the full dosage of folic acid. She and her baby are doing well in the 3rd trimester of pregnancy. Of note is that in the past she had exacerbations of her seizures with the use of birth control pills., Nocturnal Frontal Lobe Epilepsy as demonstrated by these two patients is a distinct epilepsy syndrome which may be exacerbated during pregnancy and exhibits characteristic clinical features. In particular, these patients may develop severe exacerbations of motor symptoms and seizures during pregnancy. Potential mechanisms include alterations in antiepileptic drug metabolism, hormonal factors that lower seizure threshold, and the effects of folic acid. The potential for pregnancy to exacerbate NFLE should be recognized and warrants further study and investigation.,