Case series: Fetomaternal outcome with polytherapy in pregnant women with epilepsy at a rural tertiary care hospital

Abstract

Epilepsy is most common major neurological complication encounterd in pregnancy. The etiology of seizures covers a wide range of diseases, vascular insults,infectious sequelae, malignant processes and primary central nervous dysfunction. A wide range of obstetric complications have been reported including spontaneous abortion , preterm labour, stillbirth, neonatal death, hemorrhagic disease of the newborn; low apgar and low birth weight. The incidence of malformations increase from 2.9% in the non drug user group to 3.7% in patient on monotherapy and 6.6% in patients on polytherapy. Objectives: To study the maternal and perinatal outcome in pregnant women with epilepsy on polytherapy. Materials and Methods: This retrospective observational study was conducted in R.L. Jalappa Hospital Kolar India over a period of 6 months (December 2017-june2018). Five pregnant women with epilepsy attending the antenatal clinic or admitted in labour ward in a tertiary care hospital taking two or more antiepileptic drugs were evaluated. Conclusion: Cases included in this study concludes that, despite the increased risks of pregnancy in woman with epilepsy, with appropriate clinical management with newer drugs, more than 90 percent woman with epilepsy can have successful pregnancies and better neonatal outcome. Moreover because of prepregnancy planning, counselling and optimisation of antiepileptic drug regimens and use of preconception folic acid, pregnancy outcome have become better. A higher teratogenic potential was confirmed for traditional antiepileptic drugs, particularly Valproate. Lower rates of congenital malformations were found for levetiracetam(1.7%) than in association with VPA (6.9%) © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/)