Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, United States.
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
Seizure. 2020 Aug;80:42-45. doi: 10.1016/j.seizure.2020.05.022. Epub 2020 Jun 2.
In women with epilepsy, seizure frequency and severity can be affected during pregnancy by factors such as changes in ASD (anti-seizure drug) metabolism, changes in hormone levels, and medication compliance. Some women with epilepsy experience seizure worsening during pregnancy, while others have an improvement. Most epileptic seizures during pregnancy occur in women with pre-existing epilepsy. Rarely, women develop new-onset seizure-like episodes concerning for epileptic seizures during pregnancy, posing a diagnostic and therapeutic challenge for the physician.
To determine the frequency of new-onset seizures during pregnancy and the clinical course of those with new seizures, we performed a retrospective study of all women with concomitant diagnoses of pregnancy and seizures (excluding eclampsia) at the Johns Hopkins Medical Institutions over a five-year period. We calculated the frequency of events concerning for seizures during pregnancy, including first-lifetime events, and classified these events as epileptic seizures or as seizure mimics. For those with epileptic seizures, we followed up with the patient to determine whether seizures recurred in or after pregnancy, and whether treatment with anti-seizure medication was initiated.
Over a five-year period, 41,869 women received care at Johns Hopkins Medical Institutions during pregnancy. 84 women had at least one event concerning for seizure during their pregnancies. Of these, 11 had no prior history of seizures; 5 of these women were found to have first-time unprovoked epileptic seizures supported by epileptiform abnormalities on EEG. All women delivered at term with no major complications. Four of these women continued to have epileptic seizures after delivery.
New onset seizures during pregnancy were rare. Most women with first-time epileptic seizures during pregnancy also had epileptic seizures after pregnancy, indicating a first presentation of epilepsy.
在患有癫痫的女性中，抗癫痫药物（ASD）代谢、激素水平变化和药物依从性等因素会影响妊娠期间的癫痫发作频率和严重程度。一些患有癫痫的女性在妊娠期间癫痫发作加重，而另一些则有所改善。大多数妊娠期间的癫痫发作发生在患有既往癫痫的女性中。极少数女性在妊娠期间会出现新的发作样发作，这对医生来说是一个诊断和治疗上的挑战。
为了确定妊娠期间新发癫痫的频率以及新发癫痫的临床过程，我们对约翰霍普金斯医疗系统在五年期间同时诊断为妊娠和癫痫（不包括子痫）的所有女性进行了回顾性研究。我们计算了妊娠期间与癫痫发作相关的事件频率，包括首次发生的事件，并将这些事件分类为癫痫发作或癫痫发作样发作。对于那些有癫痫发作的患者，我们与患者进行了随访，以确定癫痫是否在妊娠期间或之后复发，以及是否开始使用抗癫痫药物治疗。
在五年期间，41869 名女性在约翰霍普金斯医疗系统接受了妊娠期间的护理。84 名女性在妊娠期间至少有一次与癫痫发作相关的事件。其中 11 名女性既往无癫痫发作史；其中 5 名女性在 EEG 上发现癫痫样异常，支持首次无诱因癫痫发作。所有女性均足月分娩，无重大并发症。其中 4 名女性在分娩后仍有癫痫发作。
妊娠期间新发癫痫发作罕见。大多数在妊娠期间首次出现癫痫发作的女性在分娩后也有癫痫发作，表明这是首次癫痫发作。
