| Abstract [eng] |
Rationale: the study of this topic is relevant given the rarity, complexity, and paucity of literature on the clinical situation. Aim: to evaluate epilepsy starting in pregnancy (ESP). Objectives: review the literature on ESP; evaluate the age of epilepsy onset in women; assess ESP clinical characteristics; and compare the results to the existing literature. Methods: clinical cases were found in the Vilnius University Hospital Santaros Klinikos epilepsy registry, and the women's ages of epilepsy onset were de-identified and entered into “Excel“. The median and mean age were calculated and presented graphically. Additionally, a retrospective clinical case series analysis was made based on the de-identified data from the electronic health records. Publications on ESP were found in “PubMed“, “Web of Science“, and “Scopus“ databases. Results: there were 1086 women with known epilepsy onset, their median age of epilepsy onset was 22 years. Most frequently, the age was three (5,2%) and twelve (4,7%) years. The clinical case series analysis included 10 patients with ESP. Analysis showed that 80% of patients’ seizures were focal to bilateral, and 20% were generalized. Cognitive seizures presented in 37,5% of patients, sensory – 25%, autonomic, versive, and unknown – 12,5% each. The likely origin was temporal in 62,5% of cases and frontal or parieto-occipital in 12,5% each. The median age of epilepsy onset during pregnancy was 26,5 years. Epilepsy was diagnosed in the first (40%), second (10%), third (10%), and 40% unknown trimester. For initial treatment, levetiracetam was prescribed in 30% of cases, lamotrigine was prescribed in 20% of cases, and 20% of patients refused or did not receive treatment. In 40% of cases, the electroencephalogram (EEG) showed focal epileptiform activity, and in 10% of cases, the EEG revealed generalised epileptiform activity. Magnetic resonance imaging (MRI) showed abnormalities in the hippocampus in 40% of cases, abnormalities in white matter and abnormalities in diffuse presented in 20% of cases each, abnormalities in the basal ganglia were found 10% of cases, and 30% of patients had normal MRI findings. 30% of pregnancies were delivered by cesarean section, 30% were delivered vaginally, and one patient had an iatrogenic preterm delivery. 50% of patients achieved epilepsy remission with antiseizure medications, and one patient halted seizure generalization. Conclusions: epilepsy onset in women has two peaks: in early childhood and adolescence. Most frequently, epilepsy seizures started in the first trimester, were focal to bilateral, cognitive, and had a likely temporal origin. Half of the patients achieved medication-induced remission, and almost all had uncomplicated pregnancies. |
