PracticeUpdate Neurology Best of 2018

AAN 2018 23

Antiepileptic Treatment Maintains Seizure FreedomDuring Pregnancy and PostpartumPeriod Ongoing study now following children born to epileptic mothers taking antiepileptic drugs throughout pregnancy.

I n the first study to compare seizure frequency changes in pregnant women with epilepsy to nonpregnant women with epilepsy, the use of safe anticonvulsant medication was found to pre- vent seizures in women with epilepsy. The results suggest that there is a low risk of sei- zure recurrence during pregnancy for women who were seizure-free prior to conception and did not differ compared with nonpregnant women with epilepsy, according to research pre- sented at AAN 2018. “If you look at the population of women with epi- lepsy as a whole, having epilepsy at a younger age or during the childbearing years is relatively common,” Jacqueline French, MD, of NYU Lan- gone Medical Center in New York, told Elsevier’s PracticeUpdate . “One out of 3 women are chron- ically having seizures and the other two-thirds are potentially at risk for seizures. The vast major- ity of women are on medication.” “A lot of the work that’s been done in pregnancy and seizure recurrence has been through ret- rospective study,” Dr. French said. “This is a prospective, reasonably large study where women were recruited in the first trimester of pregnancy. And at the time they were recruited they were asked about what seizures they had prior to pregnancy. That is more rigorous than has been done with most studies looking at this. “So we followed them with digital seizure diaries that they maintained and were also reminded to keep updated. In those diaries, we looked at

whether they were being compliant with medi- cation over the course of the pregnancy. Those things were not tracked very well in previous studies. All of the women enrolled were followed in epilepsy centers that had an interest in women with epilepsy, which is why they were selected for the study. They were followed carefully clin- ically. How they were being followed and what their medications were and what drug changes were made was up to the treating physician. But these women had the best of care.” Specifically, the prospective Maternal Outcomes and Neurodevelopmental Effects of Antiepilep- tic Drugs (MONEAD) study enrolled 351 pregnant women with epilepsy and 109 nonpregnant women with epilepsy and observed them for 9 months prepartum and 9 months postpartum. Age, race, ethnicity, baseline seizure frequency, and antiepileptic drug regimens were balanced. For pregnant women with epilepsy, the number of seizures prior to enrollment but after concep- tion through day of delivery were included in the pregnancy seizure rates. In the group of pregnant women with epilepsy, 46.7% were seizure-free for the 9 months preced- ing pregnancy. For the nonpregnant group, 45.0% were seizure-free for the 9 months prior to enroll- ment. Of these seizure-free women at baseline, 84.8% of the pregnant women remained sei- zure-free during pregnancy and 87.8% during the 9 months postpartum; 85.7% of the nonpreg- nant women remained seizure-free for 9 months following enrollment, 83.7% in the subsequent 9 months. Dr. French noted that the majority of women were taking one of two antiepileptic drugs: lamotrig- ine or levetiracetam. These drugs have been shown repeatedly in previous trials to be safe and effective for pregnant women with epilepsy. She said, “There is no absolute contraindication of which [antiepileptic drugs] to use but there are definitely medications that are relatively con- traindicated because we know that they produce birth defects and/or impact cognitive outcomes in the infant. The one at the top of the list is val- proic acid.” The study also reported obstetric and postpartum outcomes. Commenting on the future of the trial, she said, “The MONEAD study is ongoing, but at the moment all of the women have passed through pregnancy and have delivered or had their out- comes and their postpartum outcomes; but we are now following their children to see what the outcomes are.” www.practiceupdate.com/c/67336

" If you look at the

population of women with epilepsy as a whole, having epilepsy at a younger age or during the childbearing years is relatively common. "

VOL. 3 • NO. 4 • 2018