Abstracts

Rationale: There is a paucity of data regarding the neurologic and obstetrical outcomes in women with epilepsy (WWE) who have undergone craniotomies prior to or at the beginning of pregnancy. This study aims to describe these outcomes in WWE who underwent craniotomies and were managed by epileptologists at a tertiary care center.

Methods: A longitudinal prospective database was utilized to select WWE who were followed in the Epilepsy clinic at Brigham and Women’s Hospital throughout their pregnancies between January 2017 and March 2022. Additional chart review was performed to retrospectively collect neurosurgical data and detailed obstetrical information. Exclusion criteria included non-adherence, non-epileptic seizures or abortion._x000D_
Results: A total of 21 women contributing to 21 pregnancies were included in the study. 20 women had craniotomies in the months or years prior to pregnancy, and in one case, craniotomy was performed during the first trimester in pregnancy. The indication for craniotomy in 15 (71.4%) cases  was for tumor resection in the setting of epilepsy which included meningioma (4), cavernoma (4), anaplastic astrocytoma (4), and oligodendroglioma (3). In 5 (23.8%) cases, craniotomy was performed due to refractory epilepsy--dysplasia and mesial temporal sclerosis were each found in 1 case. Craniotomy was performed for brain abscess in 1 (4.8%) case. Nineteen women were managed on antiseizure medication (ASM) monotherapy with lamotrigine or levetiracetam as the medication of choice in 76% of women, and 2 were on dual ASM therapy. Sixteen (76.2%) women were seizure free throughout their pregnancies. Of the 5 (23.8%) women who did have seizures, the seizure frequency during pregnancy and prior to pregnancy were similar. All women were monitored monthly with therapeutic drug monitoring. In regards to obstetrical outcomes, 2 babies were premature but did not require intensive care. Ten women (48%) underwent cesarian section, 6 of which were planned. Of the planned cesarian sections, 4 (67%) chose this method due to history of previous c-sections and 2 were explicitly chosen due to history of craniotomy. Of the 11 women who delivered vaginally, none had acute neurologic complications related to delivery; one woman with active epilepsy during pregnancy had a focal seizure the day after delivery, one developed pre-eclampsia within the week after delivery, and one had intrauterine post-partum hemorrhage. In the cesarian section group, one woman had post-partum uterine hemorrhage, two had pre-eclampsia, and there were no neurological complications. 

Conclusions: The majority of WWE who had previous craniotomies either for refractory epilepsy or for tumor resection have healthy, uncomplicated pregnancies without neurologic complications. The cesarian section rate of 48% is higher than the national average of 31.9%, though in this study over half of cesarian sections were planned due to previous cesarian sections or due to craniotomy history. Women who delivered vaginally had no acute neurologic complications. Ninety percent of women were managed on ASM monotherapy, all had stable seizure frequency, and 76% remained seizure free._x000D_
Funding: None