BOSTON—For women with epilepsy who experience seizure onset during pregnancy, the outlook is generally thought to be fairly good—that is, one of infrequent seizures and epilepsy that is easily controlled with medication. However, new data show that the prognosis for this group is not always so favorable.

In a study presented at the 57th Annual Meeting of the American Epilepsy Society, Maria C. Sam, MD, and colleagues evaluated a cohort of patients from an outpatient epilepsy clinic. One hundred case histories of women with seizures were reviewed to identify those patients with seizure onset during pregnancy as well as to analyze the degree of seizure control and quality-of-life issues.

The researchers found that five women (5%) with epilepsy had a history of onset of seizures during pregnancy. None of these patients had a definitive cause at the time of diagnosis. One patient had MRI-confirmed mesial temporal sclerosis; neurologic examination results were normal in all five patients.

Three of the five patients developed medically intractable seizures and underwent epilepsy surgery after an average of nine years (range, three to 15 years). “The three patients who underwent epilepsy surgery have obtained complete control of their seizures but remain on anticonvulsant medications,” Dr. Sam reported. “The other two patients are well controlled on anticonvulsants. ” Attempts to discontinue medications have resulted in a recurrence of seizures for both groups.

Two of the five women went on to have other pregnancies and delivered healthy children. One patient became pregnant after having undergone left temporal lobectomy and delivered a healthy baby at term. “The findings suggest that seizures with onset during pregnancy are not always easy to control,” Dr. Sam said. “Our group is small, and being in a tertiary care center may have biased our sample to patients who were more difficult to control. [However], these results highlight the importance of careful and qualified follow-up of these patients.” Dr. Sam is an Assistant Professor of Neurology at the Wake Forest University School of Medicine in Winston-Salem and Director of the Comprehensive Epilepsy Clinic.

“My advice to physicians treating this patient population is to always use the multidisciplinary approach that involves the primary care physician, a neurologist with expertise in epilepsy, and obstetrics/gynecology,” said Dr. Sam. “The team approach results in better care for our patients.”

Dr. Sam added that further studies are needed to continue to enhance the understanding of the roles that gender and pregnancy play in epilepsy and to improve the lives of women with epilepsy.

Epilepsy Onset, Menarche Age, and Fertility

BOSTON—Although previous studies have indicated a correlation between the onset of epilepsy and menarche age in women, researchers in Norway found no statistically significant relationship between epilepsy onset and the year of menarche or perimenarche. In addition, Sigrid Svalheim, MD, of the University of Oslo, and colleagues found that fertility rates for women with epilepsy starting at perimenarche, compared with rates of other women with epilepsy, were not significantly different. The investigators examined data from a cohort of 500 female outpatients, ages 18 to 45, from three hospitals. Perimenarche was defined as two years before and two years after the year of menarche. Among the 244 patients who were ultimately evaluated, the mean frequency of epilepsy was 5.4 onsets per year up to age 45. For patients with a debut age of 18 or younger, the frequency was 8.6, compared with 3.3 onsets per year for those between ages 19 and 45. For patients with onset of epilepsy between ages 1 and 18, the frequency of epilepsy at perimenarche was 9.3 onsets per year compared with 7.9 onsets per year in the remaining time period. During the year of menarche, the frequency of epilepsy onsets per year was 11. “This was not statistically different from the perimenarche years or from the mean frequency of onsets per year between 1 and 18,” the researchers reported. “There was no significant relation between epilepsy type (generalized versus partial) and menarche age. Fertility rates for those with epilepsy starting at perimenarche compared with the rest of all epilepsy patients was not significantly different.”

Suggested Reading Klein P, van Passel-Clark LM, Pezzullo JC. Onset of epilepsy at the time of menarche. Neurology. 2003;60:495-497.

NR

—Colby Stong

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