Abstracts

Rationale: Previous studies in female patients with epilepsy have largely focused on seizure status during pregnancy and on anomalies in children of patients on anti-epileptic drugs (AED). However, little is known about the influence of child-bearing on seizure recurrence after delivery in female epileptic patients in remission. We investigated the risk of seizure relapse after child-bearing. Methods: We retrospectively examined epileptic patients who had a delivery after at least two years of seizure remission. Patients had been followed for at least one year after delivery at the time of this study. We excluded patients who had a seizure recurrence following AED reduction. A total of 53 patients (72 deliveries) were included for further analysis. Patients were divided into two groups. The first group included 16 patients with long-lasting seizure remission group (five years or more), and the second group included 37 patients with relatively short seizure remission (2-5 years). The mean age at the time of the study was 44.5 years, and the mean follow-up duration was 8.4 years. The study was approved by the Ethics Committee at Tokyo Medical and Dental University. Results: A total of 17 of 53 patients had seizure recurrence during follow-up. Ten of 53 patients (18.9 %) had seizure relapse within one year after delivery, and seven patients (13.2 %) had a relapse more than one year after delivery. In the long-lasting remission group, 21.6 % (8 out of 37) had seizure recurrence. Six of these patients (16.2 %) had a seizure within one year of delivery, and two were in the long-lasting remission group (five years or more). In the group with relatively short remission, 25 % (four out of 16 patients) showed seizures within one year after delivery, and 31.3% (five out of 16 patients) had seizure relapses more than one year after delivery. Short seizure remission was a risk factor for seizure relapse after child-bearing (p<0.05). The epilepsy classification, the gender of the child, the time between marriage and pregnancy, or number of AEDs did not show any significant correlation with the risk of seizure relapses. Conclusions: It is well known that the risk of seizure relapse is relatively low in patients who have been in remission for two years or more, without a change in AED treatment. Our result showed that seizure relapse within one year after delivery is not rare, even in patients who have been seizure free for two years or more. Seizure recurrence after delivery may pose a danger not only to the patients but also to their babies. After child-bearing, patients are at risk as a result of sleep deprivation, life style changes, and dynamic changes in hormone levels. Our results may suggest that doctors should also be aware of the risk of relapse in patients who have been seizure free for years, and that they should provide lifestyle guidance to patients and their families.