Journal Reading

The Control of Treated Generalized

and Focal Epilepsies During
Pregnancy
Frank J.E. Vajda, Terence J.O’. Brien, Janet E. Graham, Alison A.
Hitchcock, Piero Perucca, Cecilie M. Lander, Mervyn J. Eadie

Presented by:

Supervised by:
 Abstract
To examine factors that contribute to failure to achieve full seizure control during
Objectives pregnancy in women wih anti-seizure medications (ASM)

● Full seizure control was not attained in 51,4% from 1223 pregnancies of
women with focal epilepsies, and in 38,7% from 1026 pregnancies in women
with generalized epilepsy
● 20.8% of women with focal epilepsy and 22.9% of women with generalized
epilepsy had convulsive seizures during pregnancy
Results
● Non-convulsive seizures occurring <1 year before pregnancy were experienced
by 82.5% of women with focal epilepsy, and 70.1% of women with generalized
epilepsy (P < 0.05)
● 22,6% and 16,4% pregnancies of women with focal and generalized epilepsy
had >1 seizure-free year before pregnancy (P < 0.05)
 Abstrak
● Younger maternal age and a longer seizure-free period in the year before
pregnancy were associated with a reduced risk of seizures during pregnancy in
Results women with generalized epilepsy. However, the risk of convulsive seizures
during pregnancy is increased in generalized epilepsy.

The risk of developing seizures during pregnancy is lower in women with

generalized epilepsy, regardless of seizure control before pregnancy. The risk of
having convulsive seizures during pregnancy is not lower in generalized
Conclusions
epilepsy than in focal epilepsy. ASM therapy appears to be less effective in
controlling focal than generalized epileptic seizures during pregnancy
 Latar Belakang
Kwan and Brodie (2000), and Chen et al (2019)
ASM therapy appears to be less effective in controlling focal than generalized
epileptic seizures during pregnancy

Seizure control rates during pregnancy are better in generalized than in

focal epilepsy

The author examines the factors that may be involved in complete seizure control in
the two main classes of epilepsy, especially during pregnancy
 Patients and Methods
The Register
• This study is based on data recorded in APR since 1999
• The data includes:

1.ASM therapy before and during pregnancy (including changes to

therapy)
2.Seizure control during pregnancy
3.Seizure-free period before pregnancy
 Patients and Methods
Study Population
2565 pregnancies of women with epilepsy recorded in the APR
316 were excluded
2249 pregnancies of women with epilepsy

1223 women with focal 1026 women with

epilepsy generalized epilepsy

Seizures during pregnancy are differentiated into convulsive and non-

convulsive seizures
 Patients and Methods
Data
Analysis

Data were analysed by univariate statistical and confidence

interval techniques, and by multiple variable logistic regression,

taking a P < 0.05 value as statistically significant.

Results
 Results
Mothers with generalized epilepsy tend to be slightly younger, have an
earlier age at onset of epilepsy, a longer period of epilepsy, and a longer
seizure-free period before pregnancy, and are more seizure-free (>1
year) in their pre-pregnancy year than women with focal epilepsy

Mothers with generalized epilepsy were more likely to experience a

change in ASM treatment before pregnancy. Major changes include
changes in doses or discontinuation of valproate intake
 Results

Women with generalized epilepsy had better seizure control from all
types of non-convulsive seizures than women with focal epilepsy before
pregnancy and continuing into pregnancy.

However, women with generalized epilepsy had higher risk to

experience convulsive seizures during pregnancy than those with focal
epilepsy, although the difference was not statistically significant.
 Results
Not taking ASM early/onset of pregnancy is associated with a lower risk
of seizures during pregnancy in women with generalized epilepsy than in
focal epilepsy.

Women with focal epilepsy who had seizures in the pre-pregnancy year
were 3.5 times more likely to have seizures (non-convulsive) during
pregnancy than those who did not have seizures before pregnancy.
 Results
Women with generalized epilepsy who had seizures in the pre-pregnancy
year were 2.59 times more likely to have seizures (non-convulsive) during
pregnancy than those who did not have seizures before pregnancy.

The odds of having convulsive seizures in women with focal epilepsy and
generalized epilepsy were 3.05 and 4.04 times higher, respectively, if they
had seizures before pregnancy than those who did not have seizures before
pregnancy.
Results
 Results
Generalized epilepsy is associated with a lower risk of seizures during
pregnancy than focal epilepsy, but is associated with a greater risk of
having convulsive seizures during pregnancy.

Changes in valproate intake and ASM before pregnancy does not change
seizure outcome
 Discussion
• Generalized epilepsy tends to be controlled more often than focal epilepsy
(during pregnancy).
• Poor seizure control before pregnancy increases the risk of non-convulsive
seizures during pregnancy

• Contemporary ASM therapy has been shown to be less effective in controlling

focal epilepsy than generalized epilepsy

• Schmidt et al → Higher circulating levels of phenytoin, phenobarbital, and

carbamazepine are required to achieve adequate control of focal non-
convulsive seizures than generalized seizures.
 Conclusions

From a clinical standpoint, it may be useful to know that having focal

epilepsy may not be disadvantageous in relation to having freedom
from convulsive seizures during ASM-treated pregnancy. However, a
woman with focal seizures is disadvantaged compared with a woman with
generalized epilepsy, as she appears less likely to have a seizure-free
pregnancy despite ASM treatment.
Thank You
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