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Denise Li<\/b><\/p>\n<\/div>\n
Li: <\/b>I would say for a lot of patients it might be, when I see them, the first time that they talk to a doctor about both of these issues in the same conversation. So, they may come into it with a lot of fear or maybe misunderstandings. And my hope is that I can give them information and give them the confidence to go through with their pregnancy.<\/p>\n
Healio: What kind of guidance or recommendations were you given on treating this population with respect to medication, medication adherence, <\/b>and <\/b>medication adjustments<\/b> prior to the latest MONEAD study?<\/b> <\/p>\n
Li:<\/b> There are national as well as international guidelines that have recommendations about monitoring drug levels of medications, continuing women on medications that are known to be safe in pregnancy, and essentially checking the levels of the drugs throughout the pregnancy and making adjustments based on changes in the drug levels as well as how the patient is doing clinically.<\/p>\n
And what was different about our study is that we had all of this great data from about how epileptologists who have an interest in pregnancy manage these patients. <\/p>\n
On a very practical level, we\u2019re talking about things like when to start changing medication doses, we\u2019re talking about the magnitude of dose changes, how often doses were changed, and that’s a much more granular description of pregnancy management compared to what there was out there before.Healio: Given previous evidence of breakthrough seizures, what are the potential risks to mothers?<\/b><\/p>\n
Pennell:<\/b> For all patients with epilepsy, seizures with altered consciousness or motor control result in a risk of injury from falls or if doing activities that would create hazards. Convulsive seizures can result in decreased oxygenation, acidosis and bodily injuries. Although rare, there is also a risk of sudden unexpected death in epilepsy (SUDEP). In pregnancy, seemingly minor blunt trauma to the abdomen can result in injury to the fetus including ruptured membranes. Additionally, there are reports that the risk of SUDEP is higher in pregnant women than nonpregnant adults with epilepsy, resulting in maternal mortality and fetal demise.<\/p>\n
Healio: <\/b>What is <\/b>the potential for <\/b>physical or developmental risks to their offspring?<\/b> Pennell:<\/b> Some of our ASMs are known to increase the risk for major congenital malformations, poor fetal growth and neurodevelopmental disorders, including autism. These are the ones we recommend avoiding in women of childbearing potential.<\/p>\n
The risk of seizures is as above and includes fetal hypoxia and acidosis with convulsive seizures, risk of blunt trauma and risk of SUDEP. There are a few studies that suggest that higher amounts of seizures in pregnancy, especially convulsive seizures, increases the risk for poor neonatal and child outcomes, but more research is needed to clarify the risk of seizures to the developing fetus. More minor seizures are not thought to have direct effects on the developing fetus. <\/p>\n
Healio:<\/b> From a clinical perspective, how do you expect the results of th<\/b>is<\/b> study to inform doctor<\/b>–<\/b>patient communication<\/b> and <\/b>interaction?<\/b> <\/p>\n
Li:<\/b> The hope is that it\u2019s more clear in the sense of that both doctors and patients feel like they understand the path forward. They don\u2019t feel like they\u2019re just wading through muddy waters in terms of what they should be doing in their pregnancy. I also wanted to highlight in this study, there\u2019s information about postpartum management as well, which there isn\u2019t a lot of out there in the literature. And then I did want to plug a website that\u2019s a good patient and physician facing resource called epilepsypregnancy.com. It was developed by epileptologists who were involved in MONEAD, and I think that\u2019s a good resource for folks to have as well.<\/p>\nFor more information:<\/h2>\n
Page <\/b>B. <\/b>Pennell, MD,<\/b> and Denise Li, MD, <\/b>can be reached at neurology@healio.com.<\/p>\n\n
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