Predictors of seizures during pregnancy in women with epilepsy

We aimed to characterize the seizure pattern during pregnancy in a large cohort of women with epilepsy (WWE) and identify possible predictors of seizure relapse during pregnancy. We recorded the antiepileptic drug (AED) use and seizure frequency for WWE during the prepregnancy month and pregnancy. The seizure profile was correlated with the clinical details and seizure type as abstracted from the clinical records maintained in the registry. Of the 1,297 pregnancies in WWE with complete seizure data, 47.8% were seizure-free during pregnancy. Seizure relapse was highest during the three peripartum days. Women with partial seizures-had higher risk of relapse (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0) than those with generalized seizures. They had two peaks of seizure relapse (second to third month and sixth month). Those with generalized seizures had one peak at first trimester. Those who were on polytherapy had increased risk of seizures (OR 2.98, 95% CI 2.3-3.9) when compared to those on monotherapy. Those who had seizures in the prepregnancy month had higher risk (OR 15, 95% CI 9-25.1) of seizures during pregnancy when compared to those who were seizure-free during that period. On multiple logistic regression, prepregnancy seizure was the most important predictor of seizures during pregnancy.     

Premature ovarian failure in women with epilepsy

PURPOSE: Women with epilepsy (WWE) have an increased risk for several reproductive endocrine disorders that may affect their fertility. The incidence of premature ovarian failure (POF) in women with epilepsy has not been systematically studied. This study examined the incidence of POF in women with epilepsy. METHODS: Fifty consecutively evaluated cognitively normal women with epilepsy, aged 38-64 years, whose seizures began before age 41 years, were interviewed for symptoms of perimenopause and menopause. Endocrine studies, performed in women aged 45 years or younger at the time of evaluation, included serum follicle-stimulating hormone (FSH; done on menstrual cycle day 3 in menstruating women), inhibin A levels when FSH was normal, thyroid-stimulating hormone (TSH), prolactin, and, in menstruating women, menstrual cycle day 20 serum progesterone level. Nonsurgical premature menopause was defined as secondary amenorrhea of >12 months' duration with FSH levels of >14 International Units (IU) in women younger than 42 years. Premature perimenopause was defined by the presence of one or more of the following: somatic perimenopausal symptoms; change in previously regular menstrual cycles without evidence of other reproductive endocrine disturbance; and FSH level of >14 IU or inhibin A level of <7 pg/ml. Similarly aged neurologically normal women seen in the menopause and sleep clinics served as control subjects. Statistical analysis included Fisher's exact test, Kruskal-Wallis test, t test, and multivariate logistic regression analysis with significance set at p < 0.05. RESULTS: Seven (14%) of 50 women with epilepsy had nonsurgical premature perimenopause (six of seven) or menopause (one of seven), compared with three of 82 control (p=0.042). Five of 41 women with localization-related epilepsy (LRE) had POF compared with two of nine women with primary generalized epilepsy (PGE; p=0.595). Mean age of POF was 39.6 years (range, 37-42 years). Seizure duration, age at seizure onset, seizure severity and lateralization, smoking history, age of menarche, body mass index and incidence of depression was not statistically different between women with and without POF. There was no statistically significant association between POF and antiepileptic drugs (AEDs). Women with POF were more likely to have had catamenial exacerbation of their seizures than were women without POF (p=0.02). CONCLUSIONS: Women with epilepsy have an increased risk for developing POF. This finding should be considered in counseling women with epilepsy on family planning.     

Folate use in women with epilepsy: Predictors of adherence in a specialized tertiary outclinic

Purpose of the studyThe aims of this study were to determine the percentage of women with epilepsy (WWE) taking folic acid (FA) in an outpatient epilepsy tertiary hospital at São Paulo, Brazil, and to identify the possible predictors of adherence.MethodFive hundred seventy-six medical records of patients followed in our service were reviewed. Sixty-six WWE using antiepileptic drugs with age between 16 and 52, sexually active but not in menopausal period, not pregnant, and not sterilized or with vasectomized partners underwent direct interviews with a prestructured questionnaire. Logistic regression with clinical and demographic variables using a stepwise method was performed to identify predictable variables of folate use.ResultsWe found 42.40% of FA intake. Hormonal contraceptive method use was an independent variable negatively associated with adherence to folate. Additionally, educational level was an independent variable positively associated with adherence to folate in WWE above 35 years of age.ConclusionWe found low folate adherence. Improved planning pre-conception for WWE should improve rates of effective folate supplementation.     

Postpartum depression in women with epilepsy versus women without epilepsy

The goal of this study was to determine if there is a significant difference in the rate of postpartum depression among patients with epilepsy and healthy controls. All patients were recruited from the Epilepsy Center and the Department of Obstetrics and Gynecology, University of Milan, St. Paolo Hospital (Milan, Italy). Thirty-five pregnant women with epilepsy and an equal number of pregnant women without epilepsy were assessed with the Edinburgh Postnatal Depression Scale (EPDS), a clinical interview used to screen for postpartum depression (PPD), and a sociodemographic questionnaire. The rate of PPD in patients with epilepsy was statistically significantly higher than that of the controls (P<0.05). PPD was present in 29% of the patients with epilepsy and 11% of the controls. In conclusion, it is very important to point out that in our pilot study, the rate of PPD was higher among women with epilepsy than among women without epilepsy. In this regard, women at higher PPD risk can be identified earlier and treated as soon as possible to alleviate their symptoms and improve their quality of life.     

Predictors of good compliance in adolescents with epilepsy

The purpose of this paper was to describe the factors that predict compliance in adolescents with epilepsy. Altogether 300 individuals aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (N= 232 ) of the selected adolescents with epilepsy returned the questionnaire.The data were analysed with SPSS software. Using the logistic regression model, the compliance of adolescents with epilepsy was predicted on the basis of support from physician and parents, motivation and the disease not being a threat of social well-being. The most powerful predictor was support from the physician. The likelihood of adolescents supported by their physicians complying with their health regimens was 10.56-fold compared with the adolescents who did not receive support from their physicians. Another powerful predictor was support from parents. The adolescents who received support from their parents complied with the health regimens with a 10.47-fold likelihood compared with adolescents who did not receive support from their parents. Adolescents with good motivation were 9.77 times more likely to comply than adolescents who did not have good motivation. Adolescents who did not feel the disease to be a threat to their social well-being complied with health regimens with an 8.38-fold likelihood compared to those who felt the disease to be a threat to social well-being.The value of the -2Log likelihood was 64.68 and the goodness of fit index was 214.735. The value of Nagelkerke was 0.893, which indicates that the logistic regression model explains 89% of the variance. The model predicts correctly 97% of compliance in adolescents showing good compliance. These values show the logistic regression model to be good and to match well with the data.     

Sexuality in women with epilepsy

Most women with epilepsy maintain normal reproductive cycles and sexual lives. However, a significant minority, approximately 20-30%, have some degree of sexual dysfunction, including problems with seizure exacerbation, libido, arousal, and orgasm. Fluctuating hormone levels may contribute to an array of reproductive cycling abnormalities. With regard to sexual dysfunction, there is some evidence of reduced genital blood flow in women with temporal lobe epilepsy. Other studies suggest that psychosocial factors, such as depression, feeling stigmatized, and being anxious about having seizures during sex, may contribute to the higher rates of sexual dysfunction in this patient population. Some antiepileptic drugs may adversely affect normal reproductive cycling and sexual function, particularly drugs that increase serotonergic transmission. Conversely, resective epilepsy surgery has been shown to restore sexual function. Treatments for sexual dysfunction include testosterone replacement, although transdermal testosterone replacement is not yet approved by the Food and Drug Administration for women. Given the possibility that women with epilepsy may experience inadequate vasocongestion during arousal, sildenafil may have a useful role, though it has not proved effective for women in general. This review focuses on potential sexual problems that are faced by women with epilepsy, with the suggestion that proper treatment may alleviate these problems.     

Predictors of pharmacoresistant epilepsy

Outcome data were analysed from 780 patients newly diagnosed with epilepsy and followed up at a single centre over a 20-year period to investigate which clinical factors predicted pharmacoresistance. Patients were divided at the time of analysis into those whose seizures had been controlled for at least the last 12 months of follow up (n=462) and those whose epilepsy remained refractory (n=318). Numbers of pre-treatment seizures were greater in uncontrolled patients. Those reporting more than 10 seizures prior to initiation of therapy were more than twice as likely to develop refractory epilepsy. Univariate and multivariate logistic regression analyses demonstrated that pharmacoresistance was also associated with family history of epilepsy, previous febrile seizures, traumatic brain injury as the cause of the epilepsy, intermittent recreational drug use, and prior or current psychiatric comorbidity, particularly depression. Factors not predicting poorer outcome included gender, neurological deficit and mental retardation. The most interesting new finding was the correlation between psychiatric comorbidity and lack of response to antiepileptic drug therapy. The deleterious neurobiological processes that underpin depression, anxiety and psychosis may interact with those producing seizures to increase the extent of brain dysfunction and thereby the likelihood of developing pharmacoresistant epilepsy.     

Treatment of women with epilepsy

Epilepsy is equally prevalent in men and women. However, for women there are unique concerns related to hormone effects on seizures and the effects of seizures and antiepileptic drugs (AEDs) on reproductive health. Steroid hormones affect neuronal excitability and seizure frequency. Some AEDs reduce the efficacy of oral contraceptive agents, increasing the probability of unplanned pregnancies. AEDs affect bone density. AEDs may alter reproductive hormones resulting in polycystic-appearing ovaries, anovulatory cycles, and infertility. Seizure frequency may change during pregnancy, seizures may cause pregnancy complications, some AEDs are teratogenic, and many cross into breast milk. The treatment of a woman with epilepsy must consider all these issues.     

Management of women with epilepsy. Practical issues faced when dealing with women with epilepsy

Epilepsy is commonly encountered in neurology practice, affecting more than 50 million people worldwide, according to the World Health Organization reports. Management of women with epilepsy requires attention to some considerations including the hormonal changes and its impact on epilepsy, the interaction between oral contraceptives and antiepileptic drugs (AEDs), pregnancy, and the potential teratogenic risk associated with AEDs use during that period. Similarly, the effect of AEDs on bone health should always be considered, and measures should be taken to reduce the risk of osteoporosis given the fact that women in their menopause are at increased risk. Despite the considerable risk of teratogenicity with AEDs use in pregnancy, more than 90% of pregnancies will be uneventful.     

Therapeutic issues in women with epilepsy

Approximately 20% of people with epilepsy are of childbearing potential and about 3 to 5 births per thousand will be to women with epilepsy. Both epilepsy and antiepileptic drugs can cause specific problems in women and embryos (less than 8 weeks of gestational age) or foetuses (more than 8 weeks of gestational age). The aim of this paper is to discuss therapeutic issues for the management of women with epilepsy: initiation of antiepileptic therapy, contraception, pregnancy, breast feeding and menopause. Some fertility issues are also discussed.     

Sex-steroid hormones in women with epilepsy

Women with epilepsy face unique challenges, in part related to changes in the seizure threshold at various times in the menstrual cycle or during their reproductive life. Ovarian sex-steroid hormones alter the excitability of the central nervous system (CNS) and alter the frequency and severity of seizures. By understanding the effects of hormones on seizures, clinicians are better equipped to treat hormonally mediated epilepsy.     

Lipid peroxidation in women with epilepsy

Background:

Lipid peroxidation is an indicator of free radical metabolism and oxidative stress in human beings and other organisms. Malondialdehyde (MDA), an end product of lipid peroxidation, is a metabolite that can be readily estimated in serum samples. Excess oxidative stress may be a final common pathway through which anti epileptic drugs may exert their teratogenic potential in pregnant women with epilepsy. Our objective in this study was to ascertain the variations in malondialdehyde (MDA) in women with epilepsy.

Material and Methods:

This study was carried out in the Kerala Registry of Epilepsy and pregnancy after obtaining clearance from the Institutional Ethics Committee. Informed consent was obtained from all the subjects. The quantitative examination of MDA was performed according to standard procedures. The ideal plasma level of MDA is below 2 nmol/ml.

Results:

Fifteen women with confirmed epilepsy (mean age 26.9 ± 3.5) were included in the study. Two women were pregnant. MDA levels ranged from 1.7 to 2.8 nmol/ml (mean level = 2.13 ± 0.37 nmol/ml). Eight women (53 %) had MDA levels above the upper limit of normal. Three patients had levels above 2.5 nmol/ml, which corresponded to the 75 centile.

Conclusions:

This study had shown that the estimation of MDA levels in plasma is a convenient method to study lipid peroxidation and thereby oxidative stress in women with epilepsy. Over half of Women With Epilepsy (WWE) have excess oxidative stress as indicated by high levels of MDA in the plasma. Correlations between MDA level and characteristics of epilepsy, AED therapy, nutritional status and other medical conditions need to be observed in a larger cohort.     

Contraception for women with epilepsy

Antiepileptic drugs that induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this affects the contraceptive regime. This effect should be considered in the choice of both the treatment of the epilepsy and the choice of contraceptive method. This review considers these interactions and offers advice about their management.     

Predictors of outcome in pediatric epilepsy surgery

OBJECTIVE: To determine the correlation between pre- and perioperative variables on the outcome of children undergoing focal resections for medically intractable partial epilepsy. METHODS: Retrospective analysis of pre- and perioperative variables in a cohort of 75 patients younger than 12 years of age who underwent excisional surgery and had at least 1 year of follow-up. Outcome, measured by postoperative seizure frequency, was analyzed as a function of age at seizure onset, duration of epilepsy, presence of cognitive impairment, lobe of seizure origin, presence of a lesion, histopathology, and completeness of resection. Completeness of resection was defined on the basis of excising both the entire structural lesion if present and the region revealing prominent interictal and ictal abnormalities on intracranial EEG. RESULTS: Seventy-seven percent of patients had good outcomes (class 1 or 2), and 59% were seizure-free. Lesional status, site of resection, and pathologic diagnoses were not significant predictors of outcome except for in multilobar resection, for which overall outcome was relatively poor (44% class 3 or 4; 22% seizure-free). Completeness of resection was the only significant predictor of good outcome (p < 0.001), with 92% of patients who underwent complete resection of the epileptogenic zone achieving good outcome compared with 50% of patients who had incomplete resections. CONCLUSION: In this series of pediatric patients, complete resection of the lesion and the electrographically abnormal region was the main determinant of outcome after focal resections. Except for multilobar resections, other factors examined in this study did not significantly influence postoperative seizure prognosis and should not influence candidate selection for the surgical process.     

Socio-familial and epilepsy specific stress on women with epilepsy

The Berlin longitudinal study on teratogenic effects of maternal epilepsy was conducted on children in 1976. Approximately 18 years later, 103 of these children's mothers were reassessed with regard to somatic, psychological, and social well-being or impairment. The families with previously diagnosed epileptic mothers (n = 59) and control families (n = 44) did not statistically differ in rates of family separation, divorce, or unemployment of the partners. There were also no significant differences in the mothers' current psychological quality-of-life status (SF-36) or their beliefs on internal or external disease control (FKK). There were, however, group differences in more closely illness-related aspects. In spite of an appreciable remission rate of 28% over the past 17 years, significantly more mothers in the epilepsy group still reported physical infirmities (GBB), reduced body-related quality of life (SF-36), and more family stress events (FAI). Their self-esteem and competence-related beliefs (FSKN) were significantly lower. They also tended to have a lower level of education or professional training, and some had never been employed. When measuring quality of life, severity of seizure (NHS3) and early epilepsy onset are the major risk factors, regardless of whether one uses epilepsy-specific (QOLIE-10) or general quality-of-life questionnaires (SF-36).