Abstract Details

Title The Risk Optimizing the Antiseizure Medication Regimen for Pregnancy Planning

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S48 - Epilepsy/Clinical Neurophysiology (EEG) III (1:11 PM-1:22 PM)

Poster/Presentation
Number 002

Background

WWE of childbearing age require careful reconsideration of their ASM type and dose, given that the maternal benefits of treatment during potential future pregnancies should be weighed against adverse effects on the developing fetus.

Objective

We report here on the retrospective arm of a retrospective-prospective study aiming to quantify percentage of reproductive-aged women with epilepsy (WWE) who fail an alteration in the antiseizure medication (ASM) regimen made for an improved reproductive safety profile.

Design/Methods

We reviewed the charts of WWE of child-bearing age (16-45), seen in the BWH Obstetric Epilepsy subspecialty clinic, BWH and MGH Epilepsy clinics between 2010-17, on a stable ASM regimen for >6 months, undergoing alterations in their ASM regimen for the specific goal of improving the outcome of a future pregnancy.

Results

We present here data for 65 WWE undergoing 80 ASM regimen changes. 55/65 (84.62%; 95%CI 73.5%-92.4%) of WWE successfully completed a first optimization of their regimen. Of the 10 WWE that failed , 5 of them (50 %) failed because of side effects, 5 of them (20%) failed because of an increase in seizure frequency.

Characteristic n(%)	Successful n = 55	Not Successful n = 10	Not Successful: SZ Increase n = 5
Seizure Freedom	40 (74.07%)	6 (60.00%)	2 (40.00%)
Focal Epilepsy	27 (49.09%)	4 (40.00%)	3 (60.00)%
Generalized Epilepsy	20 (36.36%)	4 (40.00%)	2 (40.00%)
Polytherapy	19 (34.55%)	2 (20.00%)	2 (40.00%)
>2 prior ASM trials	22 (41.51%)	3 (30.00%)	2 (40.00%)
Final Regimen with LTG	25 (45.45%)	7 (70.00%)	3 (60.00%)
Final Regimen with LEV	17 (30.91%)	2 (20.00%)	0 (0.00%)
Initial Regimen with VPA	9 (16.36%)	2 (20.00%)	2 (40.00%)

Conclusions

WWE of reproductive age have a high likelihood of successfully switching their AED regimen in preparation for future pregnancies. Possible clinical predictors of this success are discussed.

Authors/Disclosures
Paula E. Voinescu, MD (Brigham and Women'S Hospital) PRESENTER	The institution of Dr. Voinescu has received research support from Epilepsy Foundation of New England. The institution of Dr. Voinescu has received research support from BWH - Connors Center. The institution of an immediate family member of Dr. Voinescu has received research support from American Epilepsy Society. Dr. Voinescu has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Phillipines League Against Epilepsy. Dr. Voinescu has received personal compensation in the range of $500-$4,999 for serving as a PhD Opponent with University of Bergen, Norway. Dr. Voinescu has a non-compensated relationship as a Board Member and Chair with My Epilepsy Story that is relevant to AAN interests or activities. Dr. Voinescu has a non-compensated relationship as a Speaker with Epilepsy Foundation that is relevant to AAN interests or activities. Dr. Voinescu has a non-compensated relationship as a Grant Reviewer with American Epilepsy Society that is relevant to AAN interests or activities. Dr. Voinescu has a non-compensated relationship as a Member of Scientific Advisory Committee with North American AED Pregnancy Registry that is relevant to AAN interests or activities.
	No disclosure on file
Barbara A. Dworetzky, MD, FAAN (Brigham and Women's Hospital)	Dr. Dworetzky has received publishing royalties from a publication relating to health care.
Page B. Pennell, MD, FAAN (University of Pittsburgh School of Medicine)	The institution of Dr. Pennell has received research support from NIH. Dr. Pennell has received publishing royalties from a publication relating to health care.

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