Skip to main content
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Diversity, Equity, & Inclusion (DEI)
    • Neurology: Clinical Practice Accelerator
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit New Manuscript
    • Submit Revised Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Diversity, Equity, & Inclusion (DEI)
    • Neurology: Clinical Practice Accelerator
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit New Manuscript
    • Submit Revised Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

Share

February 22, 2022; 98 (8) Research Article

Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type

P. Emanuela Voinescu, Alexa N. Ehlert, Camden P. Bay, Stephanie Allien, Page B. Pennell
First published December 10, 2021, DOI: https://doi.org/10.1212/WNL.0000000000013056
P. Emanuela Voinescu
From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women’s Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women’s Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alexa N. Ehlert
From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women’s Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women’s Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Camden P. Bay
From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women’s Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women’s Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stephanie Allien
From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women’s Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women’s Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Page B. Pennell
From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women’s Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women’s Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Short Form
Citation
Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type
P. Emanuela Voinescu, Alexa N. Ehlert, Camden P. Bay, Stephanie Allien, Page B. Pennell
Neurology Feb 2022, 98 (8) e802-e807; DOI: 10.1212/WNL.0000000000013056

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
239

Share

  • Article
  • Figures & Data
  • Info & Disclosures
  • CME Course
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

Background and Objectives To assess whether increased seizure frequency during pregnancy and postpartum is influenced by epilepsy type, seizure location, and antiseizure medications.

Methods Clinical data were collected in a longitudinal prospective database of pregnant women with epilepsy at Brigham and Women's Hospital. Within each individual participant, baseline seizure frequency was calculated for the 9 months before conception, and whether seizure frequency increased during pregnancy or the postpartum period was determined. Seizure frequency was calculated for each 4-week interval during pregnancy. Generalized estimating equations for logistic regression were applied.

Results Ninety-nine patients contributing 114 pregnancies were included from 2013 to 2018. Increased seizure frequency occurred more often during pregnancies of women with focal vs generalized epilepsy (21.1% vs 5.3%, odds ratio [OR] 4.70, 95% confidence interval [CI] 1.00–22.00; p = 0.0497). Among women with focal epilepsy, increased seizure frequency occurred more often in those with frontal lobe epilepsy (OR 8.00, 95% CI 2.19–29.21; p = 0.0017). There was no difference in seizure worsening in the postpartum period between the focal and generalized (11.1% vs 9.1%; p = 0.4478) or frontal and other focal (18.8% vs 6.0%; p = 0.1478) epilepsy groups. Pregnancies on polytherapy had higher odds of seizure worsening compared to monotherapy (OR 8.36, 95% CI 2.07–33.84; p = 0.0029), regardless of the medication or epilepsy type. A lack of preconception seizure freedom was also associated with increased seizure frequency during pregnancy (OR 6.418; p = 0.0076).

Discussion Women with focal epilepsy have higher likelihood of seizure worsening during pregnancy compared to women with generalized epilepsy; frontal lobe epilepsy poses an especially elevated risk. Polytherapy and lack of preconception seizure freedom are additional predictors for an increased likelihood of seizure worsening.

Glossary

ASM=
antiseizure medication;
CI=
confidence interval;
OR=
odds ratio;
RTC=
ratio-to-target concentration;
WWE=
women with epilepsy

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • See page e876

  • CME Course: NPub.org/cmelist

  • Podcast: NPub.org/Podcast9808

  • Received January 17, 2021.
  • Accepted in final form October 25, 2021.
  • © 2021 American Academy of Neurology
View Full Text

AAN Members

We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.

Google Safari Microsoft Edge Firefox

Click here to login

AAN Non-Member Subscribers

Click here to login

Purchase access

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means.  The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use.  Distributing copies (electronic or otherwise) of the article is not allowed.

Letters: Rapid online correspondence

  • Author Response: Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type
    • P. Emanuela Voinescu, Assistant Professor of Neurology, Brigham and Women's Hospital, Harvard Medical School
    Submitted June 06, 2022
  • Reader Response: Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type
    • Aadithya Narayan Sunil Kumar, Research Assistant, JIPMER
    Submitted March 08, 2022
Comment

REQUIREMENTS

You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.

Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.

Submission specifications:

  • Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
  • Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
  • Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Publishing Agreement Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • Glossary
    • Methods
    • Results
    • Discussion
    • Study Funding
    • Disclosure
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
  • CME Course

More Online

CME Course

Safety and Efficacy of Tenecteplase and Alteplase in Patients With Tandem Lesion Stroke: A Post Hoc Analysis of the EXTEND-IA TNK Trials

Dr. Nicole Sur and Dr. Mausaminben Hathidara

► Watch

Related Articles

  • Seizure Worsening During PregnancyWho Is at Risk?

Topics Discussed

  • All Epilepsy/Seizures
  • Antiepileptic drugs
  • Epileptogenic zone

Alert Me

  • Alert me when eletters are published
Neurology: 100 (22)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Education
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2023 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise