TY - JOUR
T1 - The control of treated generalized and focal epilepsies during pregnancy
AU - Vajda, Frank J.E.
AU - Brien, Terence J.O.
AU - Graham, Janet E.
AU - Hitchcock, Alison A.
AU - Perucca, Piero
AU - Lander, Cecilie M.
AU - Eadie, Mervyn J.
N1 - Funding Information:
Conflicts of Interest: 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’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. Conflicts of Interest: 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'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. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with these guidelines.
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:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - Objectives: To examine factors contributing to failure to achieve full seizure control during pregnancy in women with anti-seizure medication (ASM) treated generalized epilepsy compared with focal epilepsy. Results: Full seizure control was not attained in 51.4% of 1223 pregnancies of women with focal epilepsies in the Australian Pregnancy Register, and in 38.7% of 1026 pregnancies in women with generalized epilepsy (P < 0.05). For convulsive seizures only, the corresponding figures of 20.8% and 22.9% were reasonably similar. Where seizures had occurred in the pre-pregnancy year, 82.5% of the focal epilepsy pregnancies were seizure affected, and 70.1% of the generalized epilepsy ones (P < 0.05). Where the pre-pregnancy year was seizure free, the corresponding figures were 22.6% and 16.4% (P < 0.05), a roughly four-fold lower rate. Maternal age, epilepsy onset age, and epilepsy duration also differed between the focal and generalized epilepsy pregnancies. Multivariate regression analysis showed that generalized epilepsy and younger maternal age were associated with statistically significant decreased risks of seizure-affected pregnancy, and having seizure-affected pre-pregnancy years with an increased risk. However, for convulsive seizures only, the risk of seizure-affected pregnancy appeared increased in generalized epilepsy. Conclusions: The risk of seizure-affected pregnancy appears lower in women with generalized epilepsy, independently of pre-pregnancy seizure control, itself a major determinant of the risk. The risk of having only convulsive seizures in pregnancy was not lower in generalized epilepsy than in focal epilepsy. ASM therapy seemed less effective in controlling focal than generalized epileptic seizures during pregnancy.
AB - Objectives: To examine factors contributing to failure to achieve full seizure control during pregnancy in women with anti-seizure medication (ASM) treated generalized epilepsy compared with focal epilepsy. Results: Full seizure control was not attained in 51.4% of 1223 pregnancies of women with focal epilepsies in the Australian Pregnancy Register, and in 38.7% of 1026 pregnancies in women with generalized epilepsy (P < 0.05). For convulsive seizures only, the corresponding figures of 20.8% and 22.9% were reasonably similar. Where seizures had occurred in the pre-pregnancy year, 82.5% of the focal epilepsy pregnancies were seizure affected, and 70.1% of the generalized epilepsy ones (P < 0.05). Where the pre-pregnancy year was seizure free, the corresponding figures were 22.6% and 16.4% (P < 0.05), a roughly four-fold lower rate. Maternal age, epilepsy onset age, and epilepsy duration also differed between the focal and generalized epilepsy pregnancies. Multivariate regression analysis showed that generalized epilepsy and younger maternal age were associated with statistically significant decreased risks of seizure-affected pregnancy, and having seizure-affected pre-pregnancy years with an increased risk. However, for convulsive seizures only, the risk of seizure-affected pregnancy appeared increased in generalized epilepsy. Conclusions: The risk of seizure-affected pregnancy appears lower in women with generalized epilepsy, independently of pre-pregnancy seizure control, itself a major determinant of the risk. The risk of having only convulsive seizures in pregnancy was not lower in generalized epilepsy than in focal epilepsy. ASM therapy seemed less effective in controlling focal than generalized epileptic seizures during pregnancy.
KW - Anti-seizure medication
KW - Control
KW - Focal epilepsy
KW - Generalized epilepsy
KW - Pregnancy
KW - Seizure
UR - http://www.scopus.com/inward/record.url?scp=85118871799&partnerID=8YFLogxK
U2 - 10.1016/j.yebeh.2021.108406
DO - 10.1016/j.yebeh.2021.108406
M3 - Article
C2 - 34775246
AN - SCOPUS:85118871799
SN - 1525-5050
VL - 125
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
M1 - 108406
ER -