Neurology: Risk comparison of seizure exacerbation in different epilepsy types before and after pregnancy: focal epilepsy may be exacerbated, especially frontal lobe epilepsy

Previous studies have shown that seizure frequency in the first nine months of pregnancy is a good predictor of seizure frequency during pregnancy, although focal epilepsy syndromes and specific antiepileptic drug (ASM) treatment may be associated with worsening seizures during pregnancy probability correlation is stronger
.

We investigated the effects of epilepsy type and seizure site, as well as ASM regimen and concentration, on seizure frequency during pregnancy and postpartum
.

Clinical data were collected in Brigham and Women's Hospital's Longitudinal Prospective Database of Pregnant Women with Epilepsy
.

• Ninety-nine patients with a total of 114 pregnancies were included between 2013 and 2018
  .
  
• Focal epilepsy was more frequent than generalized epilepsy during pregnancy (21.
  1% vs 5.
  3%, OR 4.
  70; 95% CI (1.
  00, 22.
  00); p=0.
  0497)
  .
  
• Among patients with focal epilepsy, seizure frequency increased in patients with frontal lobe epilepsy (OR 8.
  00; 95% CI (2.
  19, 29.
  21); p=0.
  0017)
  .
  
• There was no difference in the incidence of postpartum seizure exacerbations between focal and generalized (11.
  1% vs 9.
  1%, p=0.
  4478), frontal and other focal epilepsy (18.
  8% vs 6.
  0%; p=0.
  1478) groups
  .
  
• Compared with monotherapy, pregnant women who received combined therapy had a higher odds of worsening epilepsy (OR=8.
  36, 95% CI=(2.
  07, 33.
  84), p=0.
  0029), regardless of medication or epilepsy type
  .
  
• Lack of preconceived freedom from epilepsy was also associated with increased seizure frequency during pregnancy (OR=6.
  418; p=0.
  0076)
  .