Abstract Details

Title Vagus Nerve Stimulation for Epilepsy During Pregnancy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P7 - Poster Session 7 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-012

Objective To describe safety and clinical outcomes of vagus nerve stimulator (VNS) treatment during pregnancy in patients with epilepsy.

Background The vagus nerve plays an important role in uterine blood flow and contraction. The literature describing the effect of VNS on pregnancy is limited.

Design/Methods In this retrospective study, Mayo Clinic electronic medical records of VNS implantations for drug-resistant epilepsy from January 2002-April 2023 were searched to identify women who were pregnant with VNS. Charts of those identified were reviewed to extract data about maternal epilepsy, VNS treatment, and pregnancy.

Results Of 447 patients who underwent VNS implantation, 230 (51.5%) were females. There were 13 pregnancies of 9 patients. Seven were responders to VNS. VNS mean amplitude prior to pregnancy was 1 mA (range 0.5 mA to 1.5 mA). The mean age at the time of delivery was 30.5 years (range 21 to 39) and all patients were on antiseizure medications with 7 patients on more than one (mean 2, range 1 to 3). During 4 pregnancies, there was an exacerbation in seizure frequency requiring escalation of antiseizure medications, and VNS therapy was escalated in 2. Of the 13 pregnancies, one miscarriage occurred, and 7 pregnancies were characterized by additional complications, including gestational diabetes (2), severe pre-eclampsia and fetal growth restriction (FGR) requiring preterm delivery (1), FGR requiring preterm delivery (1), arrest of dilation during labor requiring cesarean section (1), and significant seizure exacerbation requiring hospitalization (1). Ten deliveries occurred at term. The average birth weight was 2.904 kg. There were no major congenital malformations (MCMs) identified.

Conclusions In this small series, there were no MCMs due to VNS teratogenesis. The pregnancy complications observed are consistent with complications previously described during pregnancy in patients with epilepsy. However, given the limited available data, further studies are needed.

Authors/Disclosures
Anhmai Vu PRESENTER	Miss Vu has nothing to disclose.
Aisha Abdulrazaq, MBBS (Mayo Clinic)	Dr. Abdulrazaq has nothing to disclose.
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
William O. Tatum IV, DO, FAAN (Mayo Clinic)	Dr. Tatum has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bioserenity. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Defense Law Firm on behalf of a patient with epilepsy with funds donated to the Epilepsy Foundation of America. The institution of Dr. Tatum has received research support from Esai. The institution of Dr. Tatum has received research support from Mayo Clinic. The institution of Dr. Tatum has received research support from Liva Nova. The institution of Dr. Tatum has received research support from Engage Pharmaceuticals. The institution of Dr. Tatum has received research support from Xenon. Dr. Tatum has received intellectual property interests from a discovery or technology relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has a non-compensated relationship as a AAN Section Chair of Clinical Neurophysiology with AAN that is relevant to AAN interests or activities.
Cornelia Drees, MD (Mayo Clinic Arizona)	Dr. Drees has nothing to disclose.
Elizabeth A. Coon, MD, FAAN (Mayo Clinic)	Dr. Coon has received publishing royalties from a publication relating to health care. Dr. Coon has a non-compensated relationship as a Non-Voting Member of the Board of Directors with UCNS that is relevant to AAN interests or activities.
Linda Szymanski (Mayo Clinic)	No disclosure on file
Brian Lundstrom, MD, PhD (Mayo Clinic, Neurology Dept)	The institution of Dr. Lundstrom has received research support from Medtronic. Dr. Lundstrom has a non-compensated relationship as a Consultant with Cadence Neuroscience that is relevant to AAN interests or activities.
Kelsey M. Smith, MD (Mayo Clinic)	The institution of Dr. Smith has received research support from CURE Epilepsy. The institution of Dr. Smith has received research support from UCB Pharmaceuticals.

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