Abstracts

Rationale: The ultimate clinical goals of an epileptologist are to reduce the overall burden of seizures for the patient, and in turn significantly improve their overall quality of life. Often this involves achieving a delicate balance of adequate seizure control while avoiding the side effects of medications. This balance becomes of particular importance in the setting of pregnancy, as the clinician is effectively treating two individuals with fluctuating physiologies and consequently medication levels. _x000D_  _x000D_ Fortunately, the emergence of newer generation anti seizure medications with improved safety and profiles has significantly reduced the overall risk of teratogenicity to the developing fetus and allowed many women with epilepsy to safely carry a healthy pregnancy to term. _x000D_  _x000D_ Methods: In this retrospective study, we compared the overall ictal burden of patients enrolled in the University of New Mexico Pregnancy with Epilepsy clinic both prenatal as well as during pregnancy. Unlike the MONEAD study, we are choosing to study the pre-pregnancy as opposed to post pregnancy ictal burden in our patients. Sleep deprivation from new infants in the household and further physiologic changes during this time make the postpartum period not entirely reflective of the patients baseline neurological status and may skew results. We explored the results of the medications Keppra, lamotrigine, and Other on the rate of seizures, increased, decreased, or unchanged in regards to the type of epilepsy generalized vs. focal. 

Results: Initially when the study group was limited to 20 individuals several trends were noted. As may be expected individuals who were not seizure free before pregnancy had a higher indigence of seizures during pregnancy.  (DF:1, X^2 10.55, p .0012) and we were unable to completely account for an increased seizure burden due to medication level changes alone (DF 2, X^2 2.24, p .33). However, there was a noted effect associated with changes in medications, such that when decreasing medications, there was an increased risk of seizure, while increasing medications decreased risks of seizures. _x000D_
After increasing our data set to 39 patients,  Looking at the effect of Keppra on seizure frequency. If changed were not made to Keppra throughout the pregnancy, 3 experienced less, 4 more, and 6 remained the same. When medication levels were adjusted, 6 had fewer, 8 more, and 12 the same seizures (P = .095). Then looking at lamotrigine changes in levels. If levels were adjusted, then 1 experienced fewer seizures, 2 more and 5 remained the same (P = .082)

Conclusions: Overall, the initial results of our study showed a statistically significant tendency for patients who are seizure free before pregnancy to remain seizure free after conception, while women who were uncontrolled before pregnancy had a higher predilection to continue having seizures during pregnancy. However, we failed to reach statistical significance of our primary goals of comparing the states of seizure changes in anti seizure medications during pregnancy. Going forward, given that the data is categorical, we may explore further regression models with this data to best serve the pregnant patients with epilepsy in the state of New Mexico. 

Funding: None