Epidemiology of epilepsy among pregnant women in the Smolensk Region

Background. Women of reproductive age account for 40% of all patients suffering from epilepsy in Russia. Epilepsy course varies during pregnancy as follows: full control (up to 66%) is achieved in most cases; alternatively, incidence of epileptic episodes remains unaltered, but disease course may deteriorate in as high as 15.8% cases. The current study was conducted within the framework of creating the Russian Register of Pregnancy and Epilepsy.

Objective: Analysis of epidemiological indicators of epilepsy and epileptic syndromes among pregnant women in the Smolensk Region.

Material and methods. Medical documentations of pregnant, parturient and puerperant women examined by a neurologist due to generalized and partial seizures in the anamnesis or occurring in ongoing pregnancy in the years 2019 and 2024 were retrospectively analyzed at the Perinatal Center of the Multidisciplinary Hospital of the Clinical Hospital No. 1 (Smolensk). Epilepsy epidemiology and pattern in pregnant women in the Smolensk Region were studied by assessing and discussing received medications, delivered obstetric care, as well as fetal congenital malformations.

Results. The total number of pregnant patients with a history of epilepsy and epilepsy syndrome comprised 28 in 2019 (7.35% of all neurological pathology cases), and 28 in 2024 (6.41%). The study demonstrated type-specific epilepsy pattern including generalized epilepsy (71.4% in 2019, 68.2% in 2024), partial epilepsy (28.6% in 2019, 31.8% in 2024). In addition, anti-epileptic therapy was assessed showing significantly increased percentage of lamotrigine use in 2024 compared to 2019 (р=0,0086). The decline in prevalence of valproic acid use in 2024 vs 2019 was insignificant (р=0,26), with the existing experience of congenital fetal malformations. The choice of delivery tactics in patients with epilepsy was in favor of Caesarean section.

Conclusion. The results suggest a need for further retro- and prospective analysis to improve managing pregnant and parturient women with epilepsy.

1. Ivanova N.E., Odintsova G.V., Oleinik A.A., Shchetinina A.M. Pregnancy and epilepsy: focus on seizure frequency changes and obstetric complications. Progress in studies and lag in practice. Nevrologiya, Neiropsikhiatriya, Psikhosomatika / Neurology, Neuropsychiatry, Psychosomatics. 2020; 12 (6): 77–82 (in Russ.). https://doi.org/10.14412/2074-2711-2020-6-77-82.

2. Karlov V.A., Vlasov P.N., Petrukhin V.A., et al. Epilepsy and pregnancy. In: Karlov V.A. (Ed.) Epilepsy in children and adult women and men. A guide for physicians. Мoscow: Binom; 2019: 672–91 (in Russ.).

3. Sidorenko V.N., Garmaza U.S. Pregnancy and epilepsy: a modern understanding of pathogenesis and diagnosis. Medical Journal. 2020; 4: 155–60 (in Russ.).

4. Vlasov P.N., Karlov V.A., Petrukhin V.A. Epilepsy and pregnancy: current therapeutic tactics. Nevrologiya, Neiropsikhiatriya, Psikhosomatika / Neurology, Neuropsychiatry, Psychosomatics. 2013; 1: 13–7 (in Russ.).

5. Yakunina A.V., Romanova T.V., Hivintseva E.V. The impact of extragenital neurological pathology on the management of pregnancy and labor. Practical Medicine. 2012; 2: 145–8 (in Russ.).

6. Thangaratinam S., Marlin N., Newton S., et al. Antiepileptic drug monitoring in pregnancy (EMPiRE): a double-blind randomised trial on effectiveness and acceptability of monitoring strategies. Health Technol Assess. 2018; 22 (23): 1–152. https://doi.org/10.3310/hta22230.

7. Stephen L.J., Harden C., Tomson T., Brodie M.J. Management of epilepsy in women. Lancet Neurol. 2019; 18 (5): 481–91. https://doi.org/10.1016/S1474-4422(18)30495-2.

8. Avakyan G.N., Blinov D.V., Avakyan G.G., et al. Restrictions on the use of valproate in female patients of reproductive age: the updated recommendations based on recent clinical data. Epilepsia i paroksizmal'nyesostoania / Epilepsy and Paroxysmal Conditions. 2019; 11 (2): 110–23 (in Russ.). https://doi.org/10.17749/2077-8333.2019.11.2.110-123.

9. Tomson T., Battino D., Perucca E. Teratogenicity of antiepileptic drugs. Curr Opin Neurol. 2019; 32 (2): 246–52. https://doi.org/10.1097/WCO.0000000000000659.

10. Pack A.M., Oskoui M., Williams Roberson S., et al. Teratogenesis, perinatal, and neurodevelopmental outcomes after in utero exposure to antiseizure medication: practice guideline from the AAN, AES, and SMFM. Neurology. 2024; 102 (11): e209279. https://doi.org/10.1212/WNL.0000000000209279.

11. Battino D., Tomson T., Bonizzoni E., et al. Risk of major congenital malformations and exposure to antiseizure medication monotherapy. JAMA Neurol. 2024; 81 (5): 481–9. https://doi.org/10.1001/jamaneurol.2024.0258.

12. Goo Y., der Nederlanden A.M., Bleasel A., et al. Dose monitoring of lamotrigine monotherapy in pregnancy: are pregnant women with epilepsy currently optimally managed? A systematic review. Ther Drug Monit. 2024; 46 (2): 181–94. https://doi.org/10.1097/FTD.0000000000001186.

13. Thangaratinam S., Marlin N., Newton S., et al. Increasing use of newer antiseizure medication during pregnancy: an observational study with special focus on lacosamide. Seizure. 2023; 107: 107–13. https://doi.org/10.1016/j.seizure.2023.02.015.

14. Yakunina A.V. Experience in the use of Seizar (lamotrigine) in women with epilepsy during pregnancy. Proceedings of the International Conference "Epilepsy and Women", Kemer, Turkey, May 28–29, 2024.

15. Avakyan G.N., Blinov D.V., Lebedeva A.V., et al. ILAE classification of the epilepsies: the 2017 revision and update. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and Paroxysmal Condi¬tions. 2017; 9 (1): 6–25 (in Russ.). https://doi.org/10.17749/2077-8333.2017.9.1.006-025.

16. Pregravid preparation. Clinical protocol of the Interdisciplinary Association of Reproductive Medicine Specialists (ARMS). Version 3.1. Moscow: Status Praesens; 2024: 124 pp. (in Russ.).