Risk factors for seizure in pregnant women with epilepsy :- Medznat
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Which factors predict seizures in pregnant women with epilepsy?

Pregnancy Pregnancy
Pregnancy Pregnancy

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In pregnant women, recent tonic-clonic seizures, a history of non-tonic-clonic seizures, and pre-pregnancy seizures markedly increase seizure risk. In general adult populations, seizure freedom and early medication reduce risk, while abnormal EEG increases risk.

An umbrella review of clinical guidelines and systematic reviews has identified multiple risk factors associated with seizures in pregnant females suffering from epilepsy and the general adult population suffering from epilepsy. Research exclusively focused on pediatrics was excluded. A wide-ranging literature search spanning 2000 to 2023 was carried out across multiple databases, including MEDLINE, Emcare, Embase, CINAHL, TRIP PRO, Epistemonikos, the World Health Organization, the Guideline International Network, and DANS, along with grey literature, without language restrictions.

Identified risk factors and predictors from the final guidelines and systematic reviews were compiled and analyzed thematically. The analysis, which included 13 studies—10 guidelines and 3 systematic reviews—examined data from 3,406 citations, highlighting 26 risk factors. Among these, 8 were specific to pregnancy, 5 were common to both pregnant women and the general adult population, and 13 applied only to adults with epilepsy. The review categorized risk factors into 5 broad themes: neurological factors,  anti-seizure medication, epilepsy and medical history,  seizure control, and seizure type.

Three factors were repeatedly cited across multiple guidelines and reviews—seizure freedom and early initiation of anti-seizure medication after a first seizure were linked to a reduced risk, while an abnormal electroencephalogram (EEG) was related to a higher risk of seizure occurrence. In pregnant women suffering from epilepsy, certain factors markedly increased seizure likelihood, including experiencing tonic-clonic seizures in the last three months, which was linked with a 7-fold rise in risk (RR 7.20).

A past history of non-tonic-clonic seizures (RR 2.11) and seizures in the year before pregnancy (RR 3.51) were also linked to a substantially heightened risk. These findings emphasize the need for improved clinical tools to predict seizures, particularly in pregnancy, where maternal and neonatal outcomes could be intensely impacted. Further research is imperative to refine risk assessment models and boost seizure prevention strategies in clinical practice.

Source:

European Journal of Obstetrics & Gynecology and Reproductive Biology

Article:

Seizure prediction in pregnant women with epilepsy: An umbrella review of clinical practice guidelines and systematic reviews

Authors:

Fatima Junaid et al.

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