Abstracts

Rationale:
Psychogenic Non-Epileptic Seizures (PNES) are often misdiagnosed and treated with antiepileptic drugs (AEDs) for years prior to formal diagnosis in an Epilepsy Monitoring Unit (EMU).  Since this condition is more common in young women, women with PNES (WWPNES) may experience pregnancy and be on unnecessary AEDs with teratogenic risk.   Overall, data on pregnancy outcomes of WWPNES, and whether they face the same increased risk of negative outcomes such as women with epilepsy (WWE), is generally lacking.  PNES status epilepticus (pseudostatus) has been described, but the frequency has not been systemically assessed.    The objective of this study was to compare maternal characteristics, seizure and pregnancy outcomes between EMU confirmed WWPNES, WWE and pregnant women without epilepsy.
Method:
Data from 2012 to 2019 were retrospectively abstracted from the electronic medical records of women who had been pregnant had an EMU confirming PNES or epilepsy, and a control group from the same medical center without epilepsy randomly selected using a 2:1 sampling ratio.  Material characteristics (age, BMI, marital status, insurance, psychiatric disorders, folic acid use, domestic abuse, antiepileptic drug use), miscarriages, pregnancy complications (pre-eclampsia, gestational diabetes, hospitalization, fetal growth restriction, pre-term delivery), and  labor outcomes (NSVD versus C-section) and neonatal outcomes (low birth weight, still born, perinatal death, NICU admit, congenital malformations) for first pregnancies were compared among the three groups using Fisher’s Exact Test for categorical data or Median Test for continuous data.
Results:
Forty-four patients were included in the analyses, 9 WWPNES, 10 WWE, and 25 controls.  Three WWE and 1 WWPNES were on TPM, none were on VPA.  Two WWE and 1 WWPNES were on polytherapy, and 7 WWE were on monotherapy. Both WWPNES and WWE had higher rates of psychiatric diagnosis compared with controls (WWPNES 66.7% vs 20.0%, p=0.03)  (WWE 60% vs 20%, p =0.016).  WWPNES and WWE were less likely to confirm that the pregnancy was planned versus controls (WWPNES 22.0% vs 68.0%, p=0.001), (WWE 20% vs 68%, p< 0.001)  Fewer WWE were married or partnered (60% vs 92.0%, p=0.004) compared to controls and PNES.  Folic acid use was lower in the epilepsy (70%) and PNES (77.8%) versus control (84%) but this was not significant.  Excluding miscarriages: WWPNES 2/8 (25%), WWE 3/7 (42%) and controls 4/25 (16%) had C-sections; preterm delivery was more common in WWE 2/7 (29%) and  WWPNES 1/8 (13 %) versus 1/25 controls (4%)- neither of these findings were significant.  Of the sample, one WWPNES had a seizure-related ICU admission for pseudostatus during labor.  Otherwise there were no significant differences among the groups for prenatal, labor or neonatal outcomes.  No maternal or neonatal deaths, or congenital malformations were seen.