Abstracts

Rationale: Epilepsy is one of the most common neurological disorders encountered during pregnancy. Despite the availability and use of many new anti-seizure agents, limited information is available regarding these agents during pregnancy. Methods: We present the preliminary results of a retrospective chart review done of all pregnant women aged 15-45yrs who were seen at the George Washington University/Medical Faculty Associates Neurology/Epilepsy clinic during Jan 2009 - Dec 2013. We reviewed the type and frequency of seizures, occurrence of status epilepticus, anti-seizure medications used and pre-natal folic acid supplementation. Results: To date we have identified 16 patients with focal and generalized types of seizures who had pregnancies during the period of review. Out of 15 subjects, 8 patients had at least one seizure during pregnancy and at least 2 of them had status epilepticus, both of which occurred during the 2^nd trimester. Two patients presented with 1^st seizure (not pre-eclampsia) and were not on any anti-seizure agents during pregnancy. Most of the patients were maintained on single anti-seizure agent during pregnancy; only 3 patients required multiple (two) agents. The majority of the patients (9 of 16) were maintained on Levetiracetam. Other anti-seizure agents used were Carbamazepine (3 patients), Lamotrigine (2 patients), Gabapentin (2 patients) and 1 patient was on Phenobarbital (in combination with Levetiracetam). Only one patient did not receive Folic acid supplementation, although there was no documentation in 5 patients. Documentation was limited for perinatal outcome and teratogenicity, partly because some of them received obstetric care at other practices. Perinatal outcome was listed as good for 4, but unavailable for 9 patients. One patient had placental abruption with delivery at 28 weeks with good outcome. Conclusions: In keeping with AAN and AES guidelines on management of pregnancy and seizures, almost all our patients were receiving folic acid supplementation. Reflecting the current trend, most of our patients are maintained on newer AEDs. Only limited information was available regarding pregnancy outcome and teratogenicity. Although in general current guidelines are being followed in our practice, more rigorous documentation is required to understand the impact of the newer anti-seizure agents on pregnancy outcome and teratogenicity.