Abstracts

Rationale: Sex hormone fluctuations are known to affect the neurobiology of epilepsy and mood disorders. In this study, we test the hypothesis that women with epilepsy (WWE) who experience seizures early postpartum have a higher risk of postpartum depression (PPD). We chose WWE on either lamotrigine (LTG) or levetiracetam (LEV) monotherapy; the former is the most commonly prescribed antiseizure medication (ASM) during pregnancy, with known mood-stabilizing effects and the latter is an ASM with known anxiogenic effects.

Methods: We included all WWE on LTG or LEV monotherapy followed at Brigham and Women’s Hospital Epilepsy-Obstetric clinics between January 2018 and December 2020. Clinical data on seizure types and frequency, therapeutic drug monitoring during pregnancy was collected in a longitudinal prospective database. Chart review was performed to obtain additional information on seizure frequency from preconception year through 6 weeks postpartum, medical history, Edinburgh Postnatal Depression Score (EPDS) score at 6-weeks postpartum. We utilized t-tests, chi-squared analysis, and multivariate logistic regression to compare variables of interest between women with different EPDS scores. Exclusion criteria: medication changes during pregnancy, abortions, non-epileptic seizures, and poor adherence.

Results: Amongst 98 WWE on LTG or LEV monotherapy, 59 had adequate information on seizures and mood to be included in the analysis. Mean age was 35 years and 79% (n = 47) were white. EPDS data is as follows: 76% (n=45) women scored 0-6 (minimal depression), 19% (n=11) women scored 7-13 (mild depression), 3% (n=2) scored 14-19 (moderate depression), and 2% (n=1) scored 20-30 (severe depression). 76% (n=45) had focal epilepsy while the rest had generalized epilepsy. 63% (n=37) women remained seizure free throughout pregnancy and postpartum. Incidence of PPD and seizure freedom throughout pregnancy were not significantly correlated (p = 0.87). Medication choice (LEV vs LTG) was not significantly associated with PPD (p = 0.86) or seizure worsening (p = 0.79). Multivariate regression analysis demonstrated that PPD is not significantly associated with any of the factors tested: age, race, epilepsy type, seizure freedom status, seizure frequency changes in postpartum compared to pregnancy or in pregnancy compared to preconception.

Conclusions: Results suggest that LTG and LEV monotherapies have a similar impact on seizure frequency during pregnancy and incidence of PPD in WWE despite their varied mood-related effects. This finding is clinically reassuring for physicians and women maintained on levetiracetam who may be concerned about PPD due to hormonal fluctuations. Additionally, seizure worsening during postpartum period did not have a strong correlation with a depressed mood in our small cohort. Future studies may benefit from including additional mood questionnaires testing for anxiety and/or mood disorders to clarify the relationship between antiseizure medications, seizure frequency, and postpartum depression.

Funding: Please list any funding that was received in support of this abstract.: N/A.