The use of newer anti-seizure medicines in women with epilepsy in pregnancy: A case series

Abstract

Epilepsy is a common serious neurological disorder, affecting approximately 28 per 10,000 pregnancies internationally each year. There are limited data on the use of newer anti-seizure medicines (ASMs) in pregnancy, despite increasing use. We aimed to describe the use of newer ASMs in women with epilepsy (WWE) attending the Rotunda Hospital, Dublin, in pregnancy, between 2018 and 2023. We conducted a retrospective case series using electronic health record data. All WWE with a medication order for a newer ASM and a completed pregnancy were included. We identified 34 pregnancies exposed to newer ASMs, namely zonisamide (35.2 %), brivaracetam (23.5 %), eslicarbazepine (23.5 %), lacosamide (17.6 %), and perampanel (2.9 %). Newer ASMs were used as monotherapy in 58.8 % cases. Levetiracetam was the most commonly prescribed concomitant ASM in polytherapy regimens (32.4 %). Seizures occurred during pregnancy or the postpartum period in 50.0 % and 14.7 % of pregnancies, respectively. Twenty-eight pregnancies (80 %) resulted in a livebirth, with median gestation and birth weight of 39 weeks' [IQR 2] and 3100 g [IQR 790]. One neonate exposed to polytherapy including eslicarbazepine was observed to have a minor anomaly at birth, not requiring follow-up. Findings show that in WWE, most pregnancies exposed to newer ASMs resulted in healthy livebirths at term without negative outcomes. A high proportion of polytherapy exposures and high rate of seizures during pregnancy suggests that this may be a cohort at greater risk for caesarean section or other complications. Findings should be interpreted with caution, with additional data needed to examine the impact of individual ASMs on outcomes.

Keywords: Brivaracetam; Eslicarbazepine; Lacosamide; Newer anti-seizure medicines; Pregnancy; Women with epilepsy; Zonisamide.

Fig. 1

Number of pregnancies exposed to newer ASMs by year. Newer ASMs included brivaracetam, eslicarbazepine, lacosamide, perampanel, and zonisamide. A line chart demonstrates total exposures and linear changes over time between 2018–2023. The highest number of pregnancies exposed to newer ASMs occurred in 2021 (26.5%), while the lowest number occurred in 2020 (5.9 %).

Fig. 2

Newer ASM exposure by pregnancy trimester for ASMs with > 1 exposure. The proportion of exposures by trimester is displayed. Where an exposure occurred only in the first trimester, this was a spontaneous miscarriage.