摘要
Background Temporal lobe epilepsy with hippocampal sclerosis(TLE-HS)is typically resistant to pharmacological interventions;however,achieving seizure freedom is possible through surgery.Our objective was to focus on the pregnancy and seizure outcomes during pregnancy of women with TLE-HS,and aim to identify predictors of seizure control.Methods The West China Registry of Pregnancy of Women with Epilepsy(WCPR_EPi)was a monocentric prospective cohort study of women with epilepsy(WWE).We screened women with TLE-HS in this database.Their clinical profile,anti-seizure medication(ASM)use,and pregnancy outcomes were extracted from the records of the registry(2010–2023).Results Out of 2320 WWE followed up,47 pregnancies in women with TLE-HS were identified and analyzed.Seizure exacerbation occurred in 40.4%of pregnancies,and seizure freedom was present in 34.0%of these during pregnancy.Factors associated with seizure exacerbation during pregnancy was ASM non-adherence(odds ratio[OR]=7.00,95%confidence interval[CI]1.43–34.07,P=0.016).The surgery group showed a significantly higher seizure freedom rate(OR=6.87,95%CI 1.02–46.23,P=0.016)and lower rate of induced labor(0.0%vs 26.5%,P=0.047)compared to the medically-treated group alone.Caesarean section was chosen in 77.1%of cases due to seizure concerns,with comparable in epilepsy-related(n=20)and obstetric causes(n=24).No major congenital malformations were reported.Conclusions Surgical treatment before pregnancy appears to offer a higher chance of seizure freedom compared to medication alone.Most of women with TLE-HS can deliver healthy offspring regardless of suboptimal seizure control and unwarranted concerns.
基金
National Natural Science Foundation of China(81901327),the Post-Doctoral Research Project of West China Hospital(2019HXBH080)
The 1•3•5 Project for Disciplines of Excellence and Brain Science at West China Hospital,Sichuan University(ZYJC21001)
Chengdu Science and Technology Bureau Program(2019-YF09-00215-SN)
China National Key R&D Program during the 14th Five-year Plan Period(No.2021YFC2401204)
Science&Technology Department of Sichuan Province(2023YFQ0109).
作者简介
Yujie Chen,contributed equally to this work;Nanya Hao,contributed equally to this work;Correspondence:Xintong Wu,36853839@qq.com;Correspondence:Dong Zhou,zhoudong66@yahoo.de。
