Paula E. Voinescu, MD, PhD: Seizure Frequency in Pregnancy, Postpartum

caring for these women we noticed that women with frontal lobe epilepsy tend to have a dramatic increase in the residual frequency so we wanted to to verify more thoroughly whether this is true or just a random observation in clinic since 2013 we have a clinical Microsoft Office Microsoft Access database that gathers information on all pregnant women with epilepsy seen at Brigham and Women's Hospital both in the epilepsy in the epilepsy and obstruct obstetrics clinic so these data has been gathered prospectively and we have information on their medication their seizure frequency and similarly we follow them in clinic and document that in their chart so these analysis was done by using this clinical database that we have and corroborating it with the information available in the patient's chart since 2013 and till 2018 we have tracked over a hundred pregnancy more precisely 114 pregnancies among these pregnancies we noticed that as it has been reported previously in the literature patients with focal epilepsy are doing worse compared to patients with Joy's epilepsy so that was not a new finding but prior publications have not looked at the localization of the seizure onset zone to see whether that was important in further stratifying this risk of seizure worsening during pregnancy we showed that within our patient populations of women with focal epilepsy have a higher risk but also women with frontal lobe epilepsy have a significantly higher risk even within the focal epilepsy group and with an odds ratio of eight which was statistically significant we also noticed that women poly therapy had a similar odds ratio of eight for an increase in their seizure frequency during pregnancy but even when correcting for poly therapy women with focal epilepsy and women with frontal lobe epilepsy were doing significantly worse the postpartum data was not that different between the swinging it we don't seem to have met the the statistical significance there but there was a difference when looking at the ratio of women who experienced an increase in seizure frequency postpartum with in the July epilepsy group compared to the focal group were the women with generalized epilepsy had an increase in that percentage of women who experienced is your frequency worsening postpartum compared to the focal epilepsy group were there was a decrease overall the percentage of women experiencing seizures seizure worsening postpartum was still higher within the focal group but the trend was definitely different postpartum for the two categories another thought was to look into the therapeutic dose monitoring because our work has previously shown that ratio to target threshold of 65 percent is significant first seizure worsening and I should pause and say that when I'm saying ratio to target concentration I'm referring to the concentration of the antibiotic medication in the patient's serum but a certain tiny and pregnancy compared to a preconception baseline so we obtained to these ratio to target concentrations for all patients with seizure worsening and they showed that the folk the frontal focal epilepsy group with seizure worsening had adequate adjustments in their ad therapy and their ratios were frequently higher than other women was focal epilepsy within that group so despite adequate those adjustments during pregnancy this women have an increase in their seizure frequency we don't quite know why this is the case why women with frontal lobe epilepsy experienced a worsening are more likely to experience a worsening of their seizure frequency during pregnancy so I think this women need to be more carefully monitored clinically during pregnancy what we notice is that in a bunch of this women we had to escalate not only the initial medication that they were under those for the initial medication that were on but also add other therapeutic methods one of our patients even got TMS during pregnancy in with hope of getting her seizures under control

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