More Proactive Management of Drug Levels Needed During First Trimester of Pregnancy and in Women on Lamotrigine

Wednesday, August 14, 2013

Drs. Battino and colleagues from a large consortium in Europe present important new data in the July 22nd early view of the journal Epilepsia. The investigators assessed prospectively 3,806 pregnancies of 3,451 women with epilepsy taking part in the EURAP, an international AED and pregnancy registry.

They analyzed this group to assess seizure control dose adjustment during pregnancy in women who are taking carbamazepine, lamotrigine, phenobarbital or valproate as their only drug.

The investigators found that the following:

  • 66.6% of women remain seizure free throughout pregnancy.

  • Generalized tonic-clonic seizures occurred in 15.2% of the pregnancies.

  • Women with idiopathic generalized epilepsies (73.6%) were more likely to remain seizure free than women with localization-related epilepsy (59.5%).

  • Worsening in seizure control from the first, the second or third trimesters occurred in almost 16% of pregnancies.

  • The AED dose was increased during pregnancy in 26%, and a second AED added to initial monotherapy in 2.6% of all pregnancies.

  • Seizures were more likely to occur in the first trimester in pregnancies with an increased drug load (35%) than in pregnancies without an increased drug load.

  • Compared with other monotherapies, pregnancies exposed to lamotrigine were less likely to be seizure free (58.2%), had more generalized tonic-clonic seizures (21.1%), and a greater likelihood of deterioration in seizure control from the first to second or third trimesters.

  • The mean dose increase from first to third trimester was 26% for lamotrigine, 5% for carbamazepine, 11% for phenobarbital, and 6% for valproate.

  • There were 21 cases of status epilepticus, 10 of which were convulsive, none with maternal mortality and only one with a subsequent stillbirth.

The investigators concluded that:

  • The majority of women remain seizure free throughout pregnancy.

  • However, one needs to have a more proactive approach to adjusting the dose of antiepileptic drugs in pregnancies, particularly for women in the first trimester and for those exposed to lamotrigine, to reduce the risk of deterioration in seizure control.

Authored by: Joseph I. Sirven MD on 8/2013

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