Folic acid supplementation in women of childbearing age with epilepsy: No association with type or number of antiepileptic drugs.

BACKGROUND: For over two decades, a daily folic acid (FA) supplementation has been recommended for women of childbearing age with epilepsy. This recommendation is based on evidence that FA administration before conception and during pregnancy can decrease the risk of fetal malformations in the general population, improve cognitive development, and reduce the risk of autistic traits in children exposed in utero to antiepileptic drugs (AEDs). OBJECTIVE: The aim of this study was to evaluate FA supplementation rate in nonpregnant women of childbearing age with epilepsy and its relation to AED type and number. METHODS: We retrospectively reviewed the computerized database and the medical records of all the women who had a first visit to our outpatient epilepsy clinic (Shamir-Assaf Harofeh Medical Center, Zerifin, Israel) during a 10-year period (2012-2021). RESULTS: Only 61 (22%) of 282 nonpregnant women of childbearing age with epilepsy treated with AEDs received FA supplementation. Ninety-two (33%) of the women were treated with AED polytherapy, and 41 (15%) received valproic acid in monotherapy or polytherapy. FA supplementation rate was higher in women aged ≤40 versus >40 (25% vs. 8.5%) (p = .004). No correlation was found between FA supplementation and AED type or number. CONCLUSIONS: FA supplementation rate was low and was unaffected by AED treatment. Patient and physician-targeted interventions should be implemented to increase FA prescription and patient adherence.

[Epilepsy in pregnancy].

Most women with epilepsy will need to continue antiepileptic drugs prior to and during pregnancy. Pre-conception counseling should be available to all wormen with epilepsy who are considering pregnancy, and should address obstetrical complications, change in seizure frequency, and adverse pregnancy outcome. Supplementation with folic acid. 0.4-5 mg/day, is recommended for all women with epilepsy of childbearing potential, especially 3 months prior to conception and throughout the first trimester. It is advisable to obtain serum drug concentrations before pregnancy, when seizure control is optimal, in order to establish a baseline. Serum concentration should be performed each trimester among patients with good seizure control, and monthly in patients with complicated epilepsy, breakthrough seizures, significant side effects, and those treated with lamotrigine or oxcarbazepine. The incidence of major congenital malformations in offspring of women treated with antiepileptic drugs has ranged from 4 to 10%, corresponding to a two-fold increase from the expected incidence in the general population. Malformation rates are higher with valproate, lower with carbamazepine and lamotrigine, and dose-effect relationship has been shown for teratogenicity especially with valproate. An expert morphological assessment, targeted at the neural axis, heart and face, should be performed at 11-13 weeks and 18-22 weeks. There is generally no contraindication to breast feeding among mothers with epilepsy, but further studies are needed to establish the safety of newer antiepileptic drugs.

Delayed post-ictal event-related potentials do not differentiate between generalized tonic-clonic seizures and syncope.

BACKGROUND: The differentiation between generalized tonic-clonic seizure (GTCS) and syncope is an important clinical problem. Corroborative investigations, which are requested when history is unclear or insufficient, have limited diagnostic value. The aim of our study was to determine whether auditory event-related potentials (ERPs) can be utilized in post-event differentiation between GTCS and syncope. MATERIALS AND METHODS: ERPs were recorded in 18 patients with a single seizure and in 21 patients following syncope, either on one or two occasions. ERP latencies and amplitudes were compared between groups and sessions. RESULTS: No significant differences of P3, N2, P2 and N1 latencies and P3, N2 and P2 amplitudes were found between patients following a single GTCS as compared to patients following syncope on either session. CONCLUSION: Post-event ERPs are insufficient to differentiate between GTCS and syncope. Further investigations are needed to evaluate the influence of different post-event intervals and ERP paradigms on ERP parameters in patients with GTCS.