Earlier epilepsy surgery may have reproductive benefits for women

January 3, 2014

By: SHARON WORCESTER, Ob.Gyn. News Digital Network

WASHINGTON – Younger age at the time of surgery, and receipt of fewer medications prior to surgery were associated with higher rates of pregnancy and birth after surgery in a study of women with epilepsy.

The findings, from a retrospective review of the charts of 113 women who underwent surgery involving cortical resection between 1997 and 2008 for intractable focal epilepsy, suggest that earlier may be better when it comes to surgical intervention for young women with epilepsy who desire pregnancy, Dr. Rachel R. Fabris reported at the annual meeting of the American Epilepsy Society.

For the women included in this analysis, the mean age was 13.3 years at epilepsy onset and the mean age was 30.5 years at time of surgery at the Mayo Clinic, Rochester, Minn. They had an average of 5.57 medication trials, 42% had at least monthly seizures, and 21% had daily seizures. They were followed for a mean of 5.7 years after surgery, and 75% had Engel Class I disease after surgery, said Dr. Fabris of the Mayo Clinic.

Prior to surgery, the women had an average of 0.93 pregnancies each, and an average of 0.73 births; after surgery, a total of 17 women had a total of 35 pregnancies and 25 births, for an average of 1.27 pregnancies and 0.96 births each.

One patient reported infertility after surgery.

Younger patients experienced the greatest increases in the number of pregnancies and births (P = .0036 and .0060, respectively), and those taking fewer medications also experienced a significant change in the number of births after surgery (P = .0362). The former finding is likely not meaningful, because younger women have higher reproductive rates than do older women, in general; the latter finding, however, may suggest a role for earlier surgical intervention in women with epilepsy, Dr. Fabris said.

These preliminary findings provide additional evidence of the importance of early surgery for intractable focal epilepsy, but their significance with respect to reproduction is uncertain given the small number of patients, she said. Dr. Fabris said she believes this to be the first study to evaluate the effect of surgery on reproductive outcomes.

"We already know from former studies that women with epilepsy have lower birth rates than women in the general population, and multiple studies have shown this to be a multifactorial process that involves an interplay of endocrine as well as societal factors," she said during a press briefing at the conference.

Since antiepileptic medications also are known to have adverse effects on fertility, it may be that this effect is contributing to the current findings, she noted, concluding that additional study with more patients is needed to provide more meaningful results. There were no relevant financial disclosures.
01/03/14