Abstracts

Rationale: Prior studies have concluded that women with epilepsy (WWE) have lower birth rates than expected. The reason for this is multifactorial and involves a complex interaction between hormonal and psychosocial factors. The effect of epilepsy surgery on reproduction in women with intractable focal epilepsy has not previously been studied. Methods: Adult women of childbearing age (18-45 years old) with intractable focal epilepsy who had undergone epilepsy surgery involving a cortical resection between 1997 and 2008 at the Mayo Clinic in Rochester, MN were included in the study. Using a retrospective chart review, data on prior pregnancies and births, epilepsy history, surgical treatment, hormonal dysfunction and socioeconomic status were obtained. Associations between various clinical and demographic variables with changes in pregnancies and births from pre to post surgery were assessed using Chi-square or Fisher s exact test for categorical variables and using Wilcoxon rank sum test for continuous variables. All tests were 2 sided and p-values less than 0.05 were considered statistically significant. All analysis was performed using SAS software version 9.2 (SAS INC, Cary NC).Results: One hundred and thirteen women (average age of 30.5 years at the time of surgery) were included in the study. Average length of follow-up was 5.7 years (range 0.25 to 15.5 years). 64 patients (57.5%) were nulliparous at the time of surgery. 61 patients (54%) had never been married. Average number of pregnancies prior to surgery was 0.93 and average number of births prior to surgery was 0.73. After surgery, a total of 17 women had a total of 35 pregnancies and 25 births. The average number of pregnancies and births after surgery was 1.27 and 0.96, respectively. Infertility was reported in only one patient postoperatively. Patients who were younger at the time of surgery experienced a greater change in the number of pregnancies and births after surgery (p=0.0036 and 0.0060, respectively). Patients who had required fewer medication trials by the time of surgery also had a greater change in the number of births after surgery (p=0.0362). Seizure onset localization and lateralization, presurgical seizure frequency, age at seizure onset, duration of epilepsy and postoperative seizure outcome were not statistically significant factors.Conclusions: The present study may provide additional compelling evidence of the importance of early surgery in women with intractable focal epilepsy. Patients who had received fewer medications prior to surgery were more likely to experience an increase in births following surgery. The significance of these findings is uncertain, but may support a role for earlier surgical intervention in the management of intractable focal epilepsy.