Women with frontal lobe epilepsy are much more likely to have an increase in seizures during pregnancy than those with focal epilepsy or generalized epilepsy, researchers report.
“Physicians need to monitor women with focal epilepsy — especially frontal lobe epilepsy — more closely during pregnancy because maintaining seizure control is particularly challenging for them,” said study lead author Dr. Paula Voinescu, a neurologist at Brigham and Women’s Hospital in Boston.
“As we know from other research, seizures during pregnancy can increase the risk of distress and neurodevelopmental delays for the baby, as well as the risk of miscarriage,” Voinescu said in a news release from the American Epilepsy Society.
In frontal lobe epilepsy, seizures begin in the front of the brain. In focal epilepsy, seizures begin in one area of the brain. In generalized epilepsy, seizures affect both sides of the brain.
The scientists analyzed 114 pregnancies among 99 women with epilepsy and found that seizures increased during pregnancy among 53 percent of those with frontal lobe epilepsy, 22.6 percent of those with focal epilepsy and 5.5 percent of those with generalized epilepsy.
Compared to the time before pregnancy, seizures were more numerous nine months after giving birth among 20 percent of those with frontal lobe epilepsy, 7 percent of those with focal epilepsy, and 12 percent of those with generalized epilepsy.
The researchers also found that an increase in seizures tended to occur among women taking more than one epilepsy drug. They also found that for women with frontal lobe epilepsy, an increase in seizures was most likely to begin in the second trimester of pregnancy.
“Frontal lobe epilepsy is known to be difficult to manage in general and often resistant to therapy, but it isn’t clear why the seizures got worse among pregnant women because the level of medication in their blood was considered adequate,” Voinescu said.
“Until more research provides treatment guidance, doctors should carefully monitor their pregnant patients who have focal epilepsy, to see if their seizures increase despite adequate blood levels and then adjust their medication if necessary,” she concluded.
The study was to be presented Monday at the annual meeting of the American Epilepsy Society, in New Orleans. Such research is considered preliminary until published in a peer-reviewed journal.
SOURCE: American Epilepsy Society, news release, Dec. 3, 2018