Seizure control during pregnancy and postpartum period in women with epilepsy: an Egyptian prospective study.

BACKGROUND: Proper seizure control during pregnancy and postpartum is essential to optimize the outcome of women with epilepsy (WWE). The current work aimed to address factors related to seizure occurrence during pregnancy and postpartum. METHODS: One hundred twenty-five WWE, compliant with their anti-seizure medications (ASMs) regimen, were prospectively evaluated for seizure control and ASMs changes all through the pregnancy up to 4 weeks postpartum. RESULTS: Most of the patients, 73 (58.4%), completed their pregnancy without seizures, while 52 (41.6%) had seizures. Only one case developed one episode of convulsive status epilepticus in the third trimester. Due to breakthrough seizures, the ASM dose was increased from the first to the third trimester in 19.2% of pregnancies, while another ASM was added in 8 pregnancies. Uncontrolled seizures during the six months before pregnancy were associated with a four-fold increase in the risk of seizures during pregnancy (95% CI 2.476-6.695). The latter nearly doubled the risk of seizures during the postpartum period (RR 1.978) (95% CI 1.44 -2.717). Furthermore, genetic etiology would increase the risk of seizures during the postpartum period by 2.7 times more than the unknown etiology (RR 2.778, 95%CI 1.156-6.679). CONCLUSION: Women with epilepsy should be counselled that proper seizure control six months before pregnancy is necessary to pass their pregnancy and the postpartum period without seizures.

Risk factors of fetal deaths and major birth defects in newborns of women with epilepsy: An Egyptian prospective study.

OBJECTIVES: Pregnancy registries for women with epilepsy (WWE) are arising all over the world. The aim of this work was to assess the risk factors of pregnancy losses and major birth defects (MBDs) of WWE through the Egyptian Registry of Anti-seizure medications and Pregnancy system. METHODS: An observational prospective study was conducted over 24 months (2018-2020). The following data were assessed: seizure control during pregnancy, Anti-seizure medications (ASMs) regimen, folic acid supplementation, and birth outcome. RESULTS: This study included 211 pregnant WWE, with mean age of 27.30 ±â€¯5.51 years. One hundred eighty-six (89.9%) patients were on ASMs, from which 110 (59.1%) patients were on monotherapy. One hundred sixty-nine (80.0%) had healthy living babies, while fetal deaths occurred in 27 patients (12.8%) (25 abortions and 2 stillbirth), two patients (1%) had neonatal deaths, while 13 patients (6.2%) had living babies with MBDs. Although taking folic acid in the first trimester was a protective of fetal deaths (RR < 1, P 0.011), it was not a protective of MBDs. Seizure freedom during the entire pregnancy regardless of seizure type was another protective factor against fetal deaths (RR < 1, P < 0.001). Polytherapy exposure significantly increased the risk of MBDs compared with monotherapies (RR > 1, P 0.014). History of previous MBD was another risk factor of MBDs (RR > 1, P 0.027). CONCLUSION: History of previous MBD and polytherapy exposure increased the risk of MBDs. Taking folic acid during first trimester and being seizure free during pregnancy were protective factors against fetal deaths.

Prognosis of Bell Palsy: A Clinical, Neurophysiological, and Ultrasound Study.

PURPOSE: Bell palsy is the most common cause of acute facial nerve paralysis. Ultrasound has proved its ability in detecting structural lesions along the course of the affected nerves.The current work aimed at studying the accuracy of ultrasound to predict the prognosis of Bell palsy in correlation to the clinical scale and nerve conduction studies. METHODS: The study included 20 cases of acute Bell palsy treated with prednisolone and physiotherapy. The participants were examined using the House-Brackmann (HB) scale, electrophysiologically and neurosonologically in the affected side and healthy side that served as a control. RESULTS: There was significant correlation between HB outcomes with onset of HB results. There was significant increase in the distal facial nerve diameter on the affected side compared with the normal side (P < 0.001). Although ultrasound at onset did not predict the outcome, nerve conduction studies did predict the outcome. CONCLUSIONS: Baseline HB clinical assessment of Bell palsy gives information on the clinical outcome of the disease. In addition to that, initial nerve conduction studies proved to be superior to ultrasound in predicting the outcome.