Clinical characteristics and pregnancy outcomes of new onset epilepsy during pregnancy

Abstract

The occurrence of seizures during pregnancy is really a challenging situation which risks the health of both mothers and fetuses. However, new onset epilepsy is unpredictable in pregnancy, and its clinic feature is barely known. This study aimed to explore the clinical characteristics and pregnancy outcomes of new onset epilepsy during pregnancy. We screened consecutive women with epilepsy and reproductive history from June 2013 to November 2018 from 3 hospitals in West China. Detailed demographics, clinical features, neurological status, related tests, managements, seizure and pregnancy outcomes were recorded and followed-up. Within them, patients with first seizure during pregnancy and spontaneous recurrent seizures after delivery or abortion were defined as new onset epilepsy during pregnancy. We screened a total of 1041 consecutive women with epilepsy and reproductive history. Twenty-two of them (2.1%) had new onset epilepsy during pregnancy. The average age at seizure onset was 22.7 ± 3.0 years. All their first seizures occurred in pregnancy period, including 4 (18.2%) in the first trimester, ten (45.4%) in the second trimester and eight (36.4%) in the third trimester. Most patients delivered healthy babies, except one patient had to choose induced abortion because of the disappearance of fetal heart rate, one child was diagnosed with mild harelip and one was diagnosed with trisomy 21 syndrome, tetralogy of Fallot and congenital duodenal atresia. All 3 complications happened in patients with their first seizures in first trimester. Although the risk of new onset epilepsy during pregnancy was relatively low, accurate diagnosis and appropriate treatment were required to reduce the damage to both mothers and fetuses. New onset epilepsy during pregnancy mostly began in middle and late pregnancy. However, seizures occurred from early pregnancy had bad effects on the embryo or fetus.

New-onset epilepsy in pregnant women: clinical features and delivery outcomes

“…As for the epilepsy and seizure type in pregnancy, in our study focal epilepsy and tonic-clonic seizures (both bilateral and generalized) were more common. This finding is in good agreement with the report by Li et al [33] showed that most patients (59.1%) suffered primary or secondary generalized tonic-clonic seizures. As for the time of occurrence of the first seizures, the pregnancy period of the first seizures was different, including 6 in the first trimester, 4 in the second trimester and 2 in the third trimester.…”

“…As for the time of occurrence of the first seizures, the pregnancy period of the first seizures was different, including 6 in the first trimester, 4 in the second trimester and 2 in the third trimester. This finding is not in line with report by Li et al showed that new-onset epilepsy occurred mostly in the second and third trimester [33].…”

“…The proportion of new-onset focal epilepsy was lower (4/116, 3.4%) in study of Yakunina et al [34]. Other studies by Tsivtsivadze et al [35] and Li et al [33] also showed the lowest rate of new-onset epilepsy during pregnancy (5/129, 4.0% and 22/1041, 2.1%, respectively). One recent study of pregnant women with epilepsy also found the lower percentage (6.0 %) of women with new onset, unprovoked epileptic seizures during pregnancy [36].…”

“…Cases of new-onset seizures in pregnancy related to Rasmussen's syndrome [28], cavernous hemangioma [29], cerebral venous thrombosis [30,31], hydrocephalus caused by aqueductal stenosis [32] have been described before. Most symptomatic seizures, however, could not be diagnosed as epilepsy, unless spontaneous recurrent seizures occurred [33]. In this study, we excluded all possible provoking causes of seizures in pregnant women and investigated the clinical features and pregnancy outcomes of women with new-onset epilepsy during pregnancy.…”

Successfully Treated New-Onset Pilocytic Astrocytoma in a Pregnant Patient

“…Three of these twenty-two (16.7%) women had positive neuroimaging findings on their MRI examinations, and none had brain tumours [5]. In at least 50% of the new epileptic cases during pregnancy, EEG examination shows no signs of epileptic activity, as in our presented case [4].…”