The Impact of Epilepsy on the Maternal and Foetal Outcome

INTRODUCTION: Epilepsy is the commonest neurological disorder seen in clinical practice. The incidence of epilepsy is 44 per 100,000 person years. The incidence in females, is 41 per 100,000 person years, and for males is 49 per 100,000 person years. The prevalence of epilepsy was slightly higher in males than females (6.5 vs 6.0 per 1000 persons) in the epileptic study reported at Rochester. In India people affected by epilepsy are more than 10 millions, constituting a prevalence of about 1% of the population. There are 2.73 million women with epilepsy in India and about 52% of them are in the reproductive age group. AIM OF THE STUDY: 1. To study the alteration of seizure frequency during pregnancy. 2. To study the outcome of pregnancy in women with epilepsy. 3. To study the outcome of delivery in epileptic pregnant women. 4. To study the effect of epilepsy, and antiepileptic drugs on the foetus and neonate. 5. To compare the outcomes of pregnancy in patients with or without preconceptal counseling. MATERIALS AND METHODS: Material/selection of subjects: WWE in the reproductive age group who were planning pregnancy or became pregnant were included in the study. Patients with epilepsy attending epilepsy clinic at Institute of Neurology Chennai and also RIOGH Egmore who were on antiepileptic drugs before and during pregnancy were enrolled. All patients followed up through out the course of pregnancy, and 3 months postpartum. Exclusion Criteria: Patients with first episode of seizure during pregnancy, seizure due to complications of diabetes or hypertension, or taking antiepileptic drugs after the first trimester were excluded. CONCLUSION: 1. Most of our pregnant patients had good seizure control before and during pregnancy. 2. In those with poor seizure control prior to pregnancy had improved seizures during pregnancy, due to stringent monitoring and care. 3. Status epilepticus occurred in one patient. 4. Most of our patients had successful vaginal delivery, in those who had caesarian section it was done for non neurological indication like cephalopelvic disproportion, foetal distress. 5. During postpartum period only four of them developed seizures. The incidence of congenital malformations, CM risk is 5.6% on monotherapy,10.0% on two drug regimen,12.5% on polytherapy. There was no neonatal deaths. It is important to educate pregnant women with epilepsy for proper planning of their pregnancies, for preconceptal folic acid intake, AED intake during the course of pregnancy, and also monitor with high resolution ultrasound for the detection of congenital malformations

Study to assess the prevalence of human leukocyte antigen-A*3101 allele among Indian epileptic patients and its influence on safety and efficacy of antiepileptic therapy

Background: The objective was to study the prevalence of human leukocyte antigen (HLA)-A*3101 allele among epileptic patients and to assess the safety and efficacy of antiepileptic therapy.Methods: 295 subjects were selected and divided into two groups, Group I had 192 epileptic patients and Group II had 103 normal healthy controls. After written informed consent, 30 ml of mouthwash sample was collected from each subject and DNA was extracted by standard salting-out technique and used for HLA-A*3101 genotyping by two-step nested allele-specific polymerase chain reaction amplification and agarose gel electrophoresis.Results: In Group I, 12 (6.25%) of the 192 patients were tested positive for HLA-A*3101 allele and all were taking carbamazepine (CBZ). Among them, 56 (30%) subjects had developed less severe adverse effects such as headache and giddiness, skin rashes and memory disturbances, and HLA-A*3101 was present in 8 of them while 136 had no adverse effects in which 4 of them were tested positive for the allele. In Group II, 3 (2.9%) of the 103 healthy controls were tested positive for the allele. No difference was found in response to antiepileptic therapy between allele positive and negative patients.Conclusion: The present study had shown that HLA-A*3101 is prevalent in 6.25% of the Indian epileptic population under study. The presence of this allele has a significant association with the development of mild cutaneous reactions like skin rashes. However, no difference was observed in allele positive patients in response to antiepileptic therapy in comparison with allele negative patients