New Tool Predicts Risk of Seizures in Pregnant Women

Highlights:

Newly developed tool accurately predicts the risk of epileptic seizures in pregnancy and up to six weeks after delivery, and can be potentially lifesaving for both the mother and her baby
The seizure risk calculator is freely available online and can be used by physicians to identify women at increased risk so that they can be closely monitored and prompt treatment is initiated
Women having epilepsy are at an increased risk of death due to seizures during pregnancy, all the more since many women discontinue their medication without specialist advice due to concerns about drug effects on their unborn baby

New risk calculator dubbed EMPiRE (AntiEpileptic drug Monitoring in PREgnancy) accurately predicts the risk of epileptic seizures in pregnancy and up to six weeks after delivery, to help initiate prompt treatment that can be potentially lifesaving for both the mother and her baby.

The tool was developed by scientists at Barts Research Centre for Women's Health at Queen Mary University of London. The details of the tool are published in the journal PLOS Medicine as well as online by the study team.

‘New freely available online tool helps predict seizure risk during pregnancy accurately and can help physicians closely monitor and treat women at increased risk of seizures.’
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Why Is Seizure Risk Calculator Important?

The risk of death in women diagnosed with epilepsy is increased ten-fold during pregnancy compared to women without the condition, all the more if women discontinue their seizure medications without informing their doctor
Many previous studies have identified that the main reason contributing to these deaths is a failure of health care professionals to recognize women at high-risk
The newly developed EMPiRE seizure risk calculator is freely available online and can be used by physicians at any point during pregnancy to identify women at increased risk so that they can be closely monitored and prompt treatment is initiated

"Although many women will place a priority on the advice of obstetrics and gynecology teams, they generally have a limited understanding of epilepsy particularly as it is not their specialty. Better advice and management is needed for pregnant women with epilepsy ."

The study team explains that the tool helps physicians to make informed decisions regarding the care of their patients and offers an overall improved outcome for both the mother and her baby.

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How The Seizure Calculator Works

The team of scientists who developed the tool validated their findings by obtaining data from the EMPiRE cohort study that studied 560 pregnant women diagnosed with epilepsy on treatment, from around 50 centers in the UK.
The tool employs uses routinely collected data during the woman’s antenatal appointment, including:

Age at first seizure
Nature of seizure
Frequency of seizures in the three months before pregnancy
Seizures that needed hospital admission, and
Current dose of anti-epileptic medications

The above data is processed to derive the seizure risk not only during pregnancy but up to six weeks after delivery as well

Professor Shakila Thangaratinam from Queen Mary University of London, said: "By identifying the women who are at greatest risk of seizures, we can monitor them more closely during pregnancy, labor and childbirth, or consider increasing their anti-epileptic drug dose to reduce that risk."

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EMPiRE Tool Benefits

The EMPiRE is the first ever risk calculator tool that accurately predicts seizure risk of pregnant women on anti-epileptic medication
It is freely available online and can be used by general practitioners, obstetricians, epilepsy specialists, and midwives
Predictions were accurate irrespective of the type of care the woman was provided
The tool correctly distinguished between women with and without seizures
The predicted risk of the tool and actually noted risk by the doctors were remarkably similar, both in low and high-risk women
Pregnant women are more likely to stick to their medication if they are aware of their risk and the fact that they will be closely monitored

Ngawai Moss, one of the participants of the study, said, "The model will be an asset for women living with epilepsy, like me, who are looking to get pregnant or already are. It will help us make informed decisions on how we manage our epilepsy and that in itself is extremely reassuring and empowering."

Epilepsy Drugs During Pregnancy Linked to Birth Defects
Epilepsy is a neurological disorder characterized by seizures. Anti-epileptic drugs during pregnancy may cause birth defects in children.

Potential Limitations of the Study

Findings are based on data mainly from high-income countries
Clinical application of the tool is limited to a threshold of 12% and above seizure risk
Small sample size of the study population

Summary

Newly developed free online tool accurately predicts seizure risk of pregnant women with epilepsy and can be easily used by doctors to make better decisions to improve the care of the patient. The tool will help pregnant women less anxious about drug effect on the baby and adhere to their seizure medications better.

References:

Predicting Seizures in Pregnant Women with Epilepsy: Development and External Validation of a Prognostic Model - (https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002802)
AntiEpileptic drug Monitoring in PREgnancy (EMPiRE): A Double-blind Randomised Trial on Effectiveness and Acceptability of Monitoring Strategies - (https://www.ncbi.nlm.nih.gov/pubmed/29737274)

Source-Medindia