Abstract Details

Title Significance of Newer Generation Anti Epileptic Drug Levels during Pregnancy: An Observational Study

Topic Epilepsy

Presentation(s) P01 - (-)

Poster/Presentation
Number 043

Objective

Background Pregnancy causes pharmacokinetic changes in AEDs. This results in increased seizures during pregnancy in one third of patients, while 65% have no change or decreased seizure frequency. Newer AEDs with lower protein binding properties still have level changes during pregnancy.

Design/Methods We performed a retrospective analysis of 37 women (age 30 years± 6 years) with epilepsy (23 partial and 14 generalized) during the course of their pregnancies. Their AED levels, dose changes and seizures were monitored. Relevance of frequent monitoring of levetiracetam and zonisamide levels was also assessed.

Results We observed 39 successful pregnancies and 2 miscarriages. Pre- pregnancy, patients were taking levetiracetam(19%), lamotrigine(16%), topiramate(13.5%), zonisamide(13.5%), oxcarbazepine(13.5%), phenytoin(11%), carbamazepine(8%) and the remainder(8%) were on valproic acid, ethosuximide, or felbamate (4 on multiple AEDs). 27 pregnancies with prior monotherapy continued the same medication. 5 patients had their AEDs changed, while 2 patients had additional medication added. Fifteen patients had breakthrough seizures during pregnancy. Among all patients, 42 dose adjustments were noted. Half of these were due to seizures, the remainder for declining AED levels. Dose titration for levetiracetam(n=3) during pregnancy was secondary to seizures that occurred despite therapeutic drug levels. Declining drug levels led to dose titration for zonisamide(n=3) even in absence of seizures. Four of the seven patients, who had lamotrigine dose titration during pregnancy, had seizures associated with decline in medication levels.

Conclusions During pregnancy, medications were adjusted for sub-therapeutic levels or breakthrough seizures. Low lamotrigine levels correlated with increased seizure incidence. Our study shows dose titration based on serum levels of zonisamide or levetiracetam do not correlate with changes in seizures frequency.

Authors/Disclosures
Swapna L. Putta, MD (Brigham and Women'S Hospital, Boston MA) PRESENTER	No disclosure on file
Akshay M. Shah, MD (San Jose Pacific Neurology)	No disclosure on file
Kogul Arumaithurai, MD (Mayo Clinic)	Dr. Arumaithurai has nothing to disclose.
Kendra Drake, MD, FAAN (Western Neuro)	Dr. Drake has nothing to disclose.
David M. Labiner, MD (University of Arizona Health Sciences)	The institution of Dr. Labiner has received research support from CDC.
Tuyen Ong	No disclosure on file

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