@article{aabe8882b2b3440c9e34dd376e46cee0,
title = "Achieving neurologically desirable outcomes to pregnancy in women with epilepsy",
abstract = "Objectives: To investigate possible factors that influenced whether pregnancy in women with epilepsy resulted in the desirable outcome of a live-born non-malformed infant and a mother whose pregnancy had been seizure free. Results: The desirable outcome, as defined, occurred in 46.3% of unselected pregnancies in the database of the Australian Register of Antiepileptic Drugs in Pregnancy (APR). The only factor investigated that had a statistically significant (P < 0.05) effect, increasing the chance of such a desirable outcome, was freedom from seizures in the pre-pregnancy year. However, anti-seizure medication (ASM) doses, particularly valproate doses, had been reduced prior to 15.6% of the pregnancies, and this may have concealed factors that otherwise may have adversely affected the desirable outcome rate. Analysis of data for monotherapy with the more commonly used ASMs appears to suggest that employing levetiracetam at the outset of antiseizure therapy may offer a better chance of a desirable outcome to future pregnancies than monotherapy with other ASMs, but this finding is not confirmed statistically. Conclusions: In pregnancies where valproate use has already been minimized, seizure control throughout the pre-pregnancy year was associated with the best chance of a desirable outcome, as defined above. In most Australian women starting therapy for epilepsy initiating treatment with levetiracetam monotherapy may offer the best chance of such a desirable outcome to a future pregnancy, yet to be confirmed.",
keywords = "Epilepsy, Fetal malformation, Levetiracetam, Pregnancy, Seizure control, Valproate",
author = "Vajda, {Frank J.E.} and O'Brien, {Terence J.} and Graham, {Janet E.} and Hitchcock, {Alison E.} and Piero Perucca and Lander, {Cecilie M.} and Eadie, {Mervyn J.}",
note = "Funding Information: FJE Vajda has received research support for the Australian Pregnancy Register from the Epilepsy Society of Australia, NHMRC, RMH Neuroscience Foundation, Epilepsy Action, Sanofi-Aventis, Eisai, UCB Pharma, and Sci-Gen. T O{\textquoteright}Brien has received research support from the Epilepsy Society of Australia, NHMRC, RMH Neuroscience Foundation, Sanofi-Aventis, UCB Pharma, and Sci-Gen and Eisai. P. Perucca is supported by the National Health and Medical Research Council (APP1163708), the Epilepsy Foundation, The University of Melbourne, Monash University, Brain Australia, and the Weary Dunlop Medical Research Foundation. He has received speaker honoraria or consultancy fees to his institution from Chiesi, Eisai, LivaNova, Novartis, Sun Pharma, Supernus, and UCB Pharma, outside the submitted work. He is an Associate Editor for Epilepsia Open. JE Graham, AA Hitchcock, CM Lander, and MJ Eadie have no relevant conflicts of interest to declare. Funding Information: We are grateful to professional and lay colleagues and bodies for referring patients to the APR, and to the Scientific Advisory Board and the Ethical Research Committees of St. Vincent's Hospital, Monash Medical Centre, the Royal Melbourne Hospital and other institutions for continuing ethics oversight of the APR. Over its years, The Epilepsy Society of Australia, The Royal Melbourne Hospital Neuroscience Foundation, Epilepsy Australia, the NHMRC and the pharmaceutical companies Sanofi-Aventis, UCB Pharma, Janssen-Cilag, Novartis, Sci-Gen, Eisai and Genzyme have provided financial support towards maintaining the Register. Publisher Copyright: {\textcopyright} 2022",
year = "2022",
month = apr,
doi = "10.1016/j.yebeh.2022.108602",
language = "English",
volume = "129",
journal = "Epilepsy & Behavior",
issn = "1525-5050",
publisher = "Academic Press",
}