Abstracts

Rationale: Women with epilepsy face a unique set of challenges during the pregnancy and post-partum period not limited to concerns of major congenital malformations (MCMs), seizures during pregnancy, anti-epileptic medication (AEDs) and drug levels and whether or not to breastfeed. We reviewed all of the patients who attended epilepsy and pregnancy clinic in our university-based center to review the fetal outcomes and challenges faced in a low-socioeconomic urban setting in Detroit, MI. Methods: All patients who attended the epilepsy and pregnancy clinic from August 2013 through May 2016 were included in the study. Patients who were referred for syncope or had not yet delivered were excluded. Patients who had suspected seizures but had not had further diagnostic testing were included. Data was analyzed after capturing baseline characteristics such as age, type and age of onset of epilepsy, seizure frequency during pregnancy, type and number of AEDs and dose per day, vitamin D level during pregnancy, outcome of fetus or pregnancy including pre-term delivery, miscarriage or death. Results: A total of 45 patients were included and the average age was 26 years (range 16-44 years). The average age of onset of epilepsy was 16.4 years (range 1-44 years). The average frequency of seizures was 1.5/month during the duration of pregnancy and fourteen patients were seizure free (29%). The types of epilepsy include unknown onset (53%), focal epilepsy (26%), primary generalized epilepsy (20%) and suspected PNES (6%). The most common AEDs were levetiracetam (48%), lamotrigine (22%) and oxcarbazepine (11%). Eleven percent did not take any AEDs. Sixty-two percent were on monotherapy (keppra and lamotrigine made up 75% of this cohort). Nine patients were receiving over the daily recommended dose for phenytoin, lamotrigine or levetiracetam by the time of delivery. One patient had received intravenous valproic acid during early pregnancy secondary to status epilepticus due to suspected encephalitis with one twin diagnosed with myelomeningocele, the only MCM in the cohort. Eight patients went into pre-term labor (17%). One had a miscarriage of twins secondary to direct trauma from a seizure. There were no statistical differences in term vs. pre-term deliveries based on seizure semiology, maternal age, average vitamin D level during pregnancy (p=0.88, Mann-Whitney Test) or seizure frequency during pregnancy (p=0.55, Mann-Whitney Test). Ten patients had unknown outcomes of their pregnancy or were lost to follow-up. Conclusions: The risk of MCMs in our population were low, likely due to the increased use of newer AEDs associated with lower risks, even when used in combination or at higher than routinely recommended dosing. The risk of pre-term labor in Detroit is 16.5% of the general population and our cohort was similar. In our university-based cohort in an urban population setting, women with epilepsy who become pregnant require closer monitoring and counseling in regards to the effects of anti-epileptic medications and seizures on pregnancy and fetal outcomes to improve overall outcomes. Funding: None