Malformations and Neonatal Problems in Babies of Mothers with Epilepsy: What are the Possible Problems in Women with Epilepsy during Pregnancy?

Objectives:This study aims to investigate the effects of epilepsy and its treatment on maternal and fetal outcomes during pregnancy. Methods: This study was designed as a retrospective observational case-control study. One hundred sixty-nine pregnant women (PW) and their newborns were included. The study group consisted of PW with epilepsy (PWWE)(mean age: 27.6 years; n=89), and the control group comprised PW without epilepsy (mean age: 27.5 years; n=80). Results:In the PWWE, unintended pregnancy was found to be higher (p<0.001). Pregnancy complications and cesarean incidence were higher in the PWWE than in the control group. Time of birth was significantly earlier in the PWWE (p<0.01). No significant difference was found between the groups concerning birth weight, height, sex of infants, and the incidence of birth complications. In the postpartum sixth week visit, all mothers in the control group were nursing their infants, whereas 11.4% of the PWWE were not nursing their infants (n=10) (p<0.05). During the study, two mothers, and one baby with severe malformation died. The prevalence of major congenital malformations (MCMs) was found as 0% in the drug-free group, 5.7% in the mono therapy group, and 8.3% in the polytherapy group, respectively. Conclusion:Although the majority of the mothers with epilepsy have a healthy pregnancy and healthy baby, we found that the mortality rate and risk of experiencing serious problems in the perinatal and postnatal period were higher compared with the controls. Neonatal disorders and congenital malformations were more common in these infants. It is important that these patients should be followed up closely during the pre-conception, pregnancy, and postpartum periods, and infants should be followed up in tertiary neonatal intensive care units when necessary

Lacosamide-Induced Visual Hallucinations and Psychosis: a Case Report and Literature Review

Lacosamide (LCM) has both frequent side effects, such as headache, diplopia, and nausea, and rare side effects such as depression, mood changes, and confusion. This article presents a case of possible LCM-induced psychosis and reviews the literature. A 22-year-old woman presented to the Emergency Department in Status Epilepticus. The seizure was treated with intravenous midazolam and valproic acid. However, she developed cardiopulmonary arrest and was resuscitated successfully. She was intubated and admitted to the intensive care unit. She had first been diagnosed with epilepsy 15 years earlier and had been seizure-free for 3 years. She had undergone a sleeve gastrectomy 1 year earlier. She was extubated the day after admission. LCM 200 mg/day was added to the treatment because of generalized seizures beginning in the right arm. Her seizures were controlled on the 4th hospital day. However, after starting LCM, she developed agitation, visual hallucinations with a sexual content, and intellectual delusions. Therefore, the LCM was discontinued and her psychosis resolved completely 4 days later. On the 12th hospital day, she was discharged. LCM blocks sodium channels and can act as a mood stabilizer and sedative. However, our patient developed psychosis with LCM treatment. This is the first reported case of LCM-induced psychosis in Turkey. Visual hallucinations and psychosis may develop immediately after starting LCM therapy. Clinical recovery can be achieved by discontinuing the drug

Cost of Inpatient Treatment of Patients with Status Epilepticus in Turkey

Objectives:Status epilepticus (SE) is a neurological emergency with high mortality. As there are no data on the cost of treatment of SE in this country, the aim of this study was to investigate and analyze these costs.Methods:Patients who were hospitalized in the neurology intensive care unit between January and August 2018 were retrospectively evaluated. Demographic data, SE type, etiological factors, antiepileptic drugs used, duration of hospitalization, total cost of hospitalization, and the cost of medication(s) were recorded.Results:The records of 15 patients (male/female: 4/11) with a mean age of 46.73 years were examined. Seven patients had no previous history of epilepsy and their first seizure was SE-like. The seizures were classified as primary generalized convulsive (n=5), focal onset generalized convulsive (n=6), focal motor (n=1), and non-convulsive (n=3) SE. Medication mismatch (n=4), systemic infection (n=4), previous stroke (n=2), acute stroke (n=3), metabolic causes (n=1), and iatrogenic causes (n=1) were found in the seizure etiology. Two patients died during followup. The mean length of time of hospitalization in the neurology service and intensive care unit was 5.7 and 13.2 days, respectively. The mean total cost of the treatment per patient was TL 22,202.86 and the mean drug cost was TL 4,630.73.Conclusion:The presence of an acute central nervous system etiology and advanced age of the patient are 2 important factors that significantly increased the cost. More comprehensive data are needed to investigate the risk factors that contribute to the cost of larger patient numbers in our country

Development of Insulin Resistance in Patients with Epilepsy During Valproate and Carbamazepine Monotherapy

Objectives:This study investigated the development of insulin resistance (IR) secondary to the use of valproic acid (VPA) and carbamazepine (CBZ), which are highly effective and frequently used antiepileptic drugs.Methods:This cross-sectional prospective cohort study included 111 participants aged 15 to 64 years. Patients diagnosed with epilepsy were divided into 2 groups: those using VPA (n=45) and those using CBZ (n=35). Those groups were compared to healthy control group (n=31). Preprandial blood glucose, insulin, C-peptide levels were examined, and IR was calculated. Anthropometric measurements were taken.Results:A significant relationship was identified between VPA or CBZ use and development of IR (p<0.05). C-peptide level was significantly higher in patients who used antiepileptic drugs than in control group (p<0.05). Average body mass index (BMI) was not different between groups.Conclusion:In patients under antiepileptic treatment, neuroendocrine dysfunction, such as insulin metabolism disorders, can develop in addition to common side effects. Thus, symptoms should be followed up carefully and patients should be evaluated in terms of side effects both before starting and during treatment

The effect of sleep disorders on quality of life in patients with epilepsy: A multicenter study from Turkey

Objective: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. Methods: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. Results: The mean age of 1358 patients was 35.92 ± 14.11 (range, 18–89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ± 8.14 (10–48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440–5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128–1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034–1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 – 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084–1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004–1.041]; p = 0.014), were determined as factors affecting quality of life. Significance: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy