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Abstract Details

Women with Epilepsy and Postpartum Toxicity: A Retrospective Analysis
Epilepsy/Clinical Neurophysiology (EEG)
Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)
078
Determine prevalence and onset of anti-seizure drug (ASD) toxicity in women with epilepsy (WWE) postpartum.  
During pregnancy and the postpartum period, ASD clearance fluctuates, resulting in changes in ASD levels that may result in toxicity. Postpartum, WWE may experience many physiologic, hormonal, and sleep changes that may result in ASD level and possible seizure deterioration.    

Eighty-one medical records for pregnant WWE > 18 years old on ASD treatment from the University of Minnesota/MINCEP Epilepsy Center were retrospectively reviewed for symptoms of potential ASD toxicity including double vision, dizziness, mood changes, excessive fatigue, and falls. Subjects with no follow-up postpartum were excluded. The timing of reported symptoms (in weeks postpartum) and ASD regimen were recorded with each encounter.  

Fifty-five pregnancies (46 women) were included. Most common ASDs were lamotrigine (LTG) (n=36 pregnancies), Levetiracetam (LEV) (n=27 pregnancies), and Oxcarbazepine (OXC) (n=6 pregnancies), either in monotherapy or polytherapy.   

 

Of the 36 pregnancies on LTG in monotherapy or polytherapy; 16 (44.4%) pregnancies reported multiple ASD toxicity symptoms. Commonly reported symptoms include dizziness (n=12, 33%), double vision (n=8, 22%), and excessive fatigue (n=4, 11%). Fourteen out of 36 (39%) pregnancies on LTG reported toxicities between 1-8 weeks in the postpartum period and 9 (25%) had peak LTG toxicity 2-weeks postpartum.  

  

Of the 27 pregnancies on LEV, 26 (96%) reported no obvious ASD toxicity symptoms. One woman developed headaches. Depression associated with LEV was difficult to differentiate from postpartum depression. None of the women on OXZ reported ASD toxicity symptoms.   
Symptoms of ASD toxicities postpartum in WWE were commonly reported with LTG, mainly 2-weeks postpartum.  Pregnant WWE on LTG may benefit from careful postpartum clinical management, LTG dose reduction, and education. Further research is needed to define the best clinical practices for ASD modifications during postpartum care.     
Authors/Disclosures
Leslie Siegel, PharmD (Parkview Health)
PRESENTER 		Ms. Siegel has nothing to disclose.
Angela K. Birnbaum, PhD (University of Minnesota) The institution of Dr. Birnbaum has received research support from National Institutes of Health. The institution of Dr. Birnbaum has received research support from Randy Shaver Cancer and Research Foundation. Dr. Birnbaum has received intellectual property interests from a discovery or technology relating to health care.
No disclosure on file
Sima I. Patel, MD (UMP) Dr. Patel has nothing to disclose.