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

Abstract

Introduction: Most seizures during pregnancy occur in women who already have epilepsy. Rarely, some women may have their first seizure during pregnancy. The purpose of this study was to investigate the clinical features and pregnancy outcomes in women with new-onset epilepsy during pregnancy. Methods: 112 pregnant women with epilepsy were prospectively evaluated at the Education -Therapeutic Clinic of the Azerbaijan Medical University, in the neurological and maternity departments of the Clinical Medical Center in Baku over a six-year period. Women were regularly followed by a neurologist and obstetrician till the end of pregnancy. To determine the recurrence of seizures during the pregnancy and after delivery, the women were followed up at least once per three months for a one year period after delivery. Delivery and perinatal outcomes were compared with those of 277 healthy women in the control group (without epilepsy and without registering chronic diseases). Results: Of the 112 pregnant women with epilepsy, 12 (10.7%) had their first seizures during the pregnancy: 6 in the 1 st , 4 in the 2 nd , 2 in the 3 rd trimester. Women with new-onset epilepsy had increased risk of cesarean section and perinatal hypoxia in offspring, compared with controls (Odds ratio [OR]: 13.57; 95% confidence interval (CI):2.86-64.31 and OR: 3.61; 95 % CI: 1.06-12.27, respectively). The risks of cesarean section and perinatal hypoxia were not increased in women with new-onset epilepsy compared to women with epilepsy before pregnancy (OR 2.64; 95 % CI 0.54-12.93 and OR 2.18, 95% CI 0.61-7.76, respectively). Conclusion:In our cohort, women with new-onset epilepsy may have an increased risk of delivery by cesarean section and perinatal hypoxia compared to pregnant controls. The risks were not increased compared to women with epilepsy before pregnancy. Neonatal hypoxia was associated with delivery by cesarean section.

New-onset seizure in pregnancy: case report and literature review

“…Melikova stud ied 70 preg nant women with fo cal ep i lepsy and 8 (11.4%) of them presented with a first-time ep i lep tic sei zure dur ing preg nancy [8]. In an other study from Azerbaijan, 112 preg nant women with ep i lepsy were eval u ated and 12 (10.7%) had their first sei zures dur ing preg nancy [3]. The dif fer ent propor tions of ges ta tional on set ep i lepsy re corded in these stud ies may be due to dif fer ent pop u la tions, dif fer ent inclu sion cri te ria, for ex am ple, in some stud ies only women with fo cal ep i lepsy were in ves ti gated.…”

“…In ad di tion, the higher prev a lence of new-on set ep i lepsy dur ing preg -nancy may be a re sult of un der-rec og nized fo cal sei zures be fore preg nancy. The di ag no sis of ep i lepsy is not al ways def i nite at the on set of symp toms, es pe cially when seizures oc cur not so of ten and some types of sei zures may be underdiagnosed [3].…”

“…The preva lence of ep i lepsy is be tween 4 and 10 per 1000 peo ple in the de vel oped world; con se quently, ep i lepsy is one of the most com mon neu ro log i cal dis or ders af fect ing women of re pro duc tive age [2]. Sei zures dur ing preg nancy mostly oc cur in women who were al ready di ag nosed with ep i lepsy be fore preg nancy, but some times some women may have new-on set sei zures dur ing preg nancy, al though this sit u ation is quite rare [3]. Causes of sei zures in preg nancy can be grouped into three cat e go ries.…”

“…Some times sei zures oc cur only dur ing pregnancy and women are sei zure-free be tween preg nan ciesthis rare con di tion is termed ges ta tional ep i lepsy. An other rare type of ep i lepsy is ges ta tional on set ep i lepsy; in this case, women have the first sei zure dur ing preg nancy and since then spon ta ne ous re cur rent sei zures con tinue to occur even af ter la bour [3]. The sec ond cat e gory is new-on set sei zures caused by a con di tion that is not re lated to pregnancy, such as brain tu mours, cerebrovascular events, infec tions, or met a bolic de range ments.…”