Abstracts

Rationale: There are over 1 million adult women with epilepsy in the United States alone. One out of every 200 pregnancies involves a woman with active epilepsy. Although some small studies have associated the type of seizure (focal versus generalized) with relative refractoriness of seizures, there are no known reliable predictors of increased seizure during pregnancy. Prolonged seizures and status epilepticus are known threats to both the mother and the fetus. This study evaluates the self-discontinuation of anti-convulsant therapy as a potential cause of increased seizure frequency in pregnant women with epilepsy. Methods: A retrospective cohort study design was applied using a tertiary care neurology department billing database from 2006-2010. To be included, the patients must have been billed for their visits under the codes epilepsy conditions (780.30 or 345.xx) and maternity (v22.xx), diagnosed with epilepsy by a neurologist or epileptologist, and seen while pregnant (N=128). If more than one pregnancy, only the first pregnancy was included. One physician reviewed each individual chart and collected all of the descriptive data points. Results: 96 pregnant women with epilepsy met the inclusion criteria. The mean age was 26 years old, standard deviation 5.65 years, range 16- 40 years. The mean gestational age (GA) at which the patient had her first visit to a neurologist was 22 weeks, SD 9.53 weeks, and range 4- 40 weeks. The majority of pregnant women had less than or equal to a twelfth grade education 87.5% (N= 21 of 24); 99% of the women had prescription drug coverage. The mean number of neurology encounters per pregnancy was 1.9, SD 1.3, and range 1 to 6. The seizure type was predominately primary generalized (N=69, 72%), specifically juvenile myoclonic epilepsy (JME) (N=15), generalized +/- NES (N=7), and generalized +/- syncope (N=3). In the focal seizure group (27 patients, 28%), 11 (41%) also experienced secondary generalization. Of the 96 women, 15 self-discontinued their anti-convulsant medication without their physicians' knowledge and 15 experienced an increase in seizure frequency. 11 of the 15 women with increased seizure frequency had self-discontinued their medication (versus 4/81 without an increase in seizure frequency)(p <0.05) and 11/15 pregnant women who self-discontinued anti-convulsant therapy had an increase in seizure frequency (versus 4/81 who had not self-discontinued their anticonvulsant) (p <0.05). Six (40%) of the pregnant women who self-discontinued their anti-convulsant medications did so prior to neural tube closure and 3 (20%) did so because of advice given to them directly by their pharmacist. Conclusions: Based on a sample of 96 pregnant women with epilepsy, an increase in seizure frequency was statistically significantly associated with self-discontinuation of anticonvulsants. Educating pharmacists and epileptic women of childbearing potential about the importance of continuing anti-convulsant therapy during pregnancy may yield considerable benefits.