Objective

Epilepsy treatment during pregnancy is still challenging. The study is aimed at comparing the efficacy and safety of carbamazepine (CBZ), lamotrigine (LTG) and levetiracetam (LEV) monotherapies during pregnancy in women with focal (FE) or generalized (GE) epilepsy.

Methods

A multicentre retrospective study was conducted to evaluate seizures frequency and seizure freedom (SF) rate during 3 months before pregnancy, each trimester of gestation and post-partum period in women on monotherapy with CBZ, LTG and LEV.

Results

Fifty-seven pregnancies (45 FE, 12 GE) on monotherapy (29 CBZ, 11 LTG, 17 LEV) were included. A significant reduction of seizure frequency was found in the first trimester of pregnancy as compared with that one before pregnancy (p = 0.004), more evident in GE (p = 0.003) and in LEV group (p = 0.004). The SF rate significantly increased in the first trimester in comparison to that one before pregnancy and persisted in the post-partum period in the whole sample (p < 0.001) and in women on LEV (p = 0.004). Besides, 88.57% of SF women before pregnancy remained unchanged during gestation and the post-partum period. One major heart malformation in CBZ and no major malformations in LTG and LEV groups were found.

Conclusions

A better clinical outcome during pregnancy emerged since the first trimester in comparison to the before-pregnancy period, mostly evident in women with GE and LEV therapy, reinforcing the hypothesis of a protective role of pregnancy versus seizures. SF before pregnancy represents a significant predictive factor of good clinical outcome during gestation and the post-partum period. Compared to CBZ, LTG and LEV showed a better safety profile.

中文翻译：

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左乙拉西坦、拉莫三嗪和卡马西平：孕期哪种单一疗法？

客观的

怀孕期间的癫痫治疗仍然具有挑战性。该研究旨在比较卡马西平 (CBZ)、拉莫三嗪 (LTG) 和左乙拉西坦 (LEV) 单一疗法在妊娠期间对局灶性 (FE) 或全身性 (GE) 癫痫女性的疗效和安全性。

方法

进行了一项多中心回顾性研究，以评估使用 CBZ、LTG 和 LEV 单药治疗的女性在怀孕前 3 个月、妊娠的每个三个月和产后期间的癫痫发作频率和癫痫发作自由 (SF) 率。

结果

纳入了 57 例接受单药治疗（29 CBZ、11 LTG、17 LEV）的妊娠（45 FE，12 GE）。与怀孕前相比，妊娠头三个月的癫痫发作频率显着降低 ( p  = 0.004)，在 GE ( p  = 0.003) 和 LEV 组 ( p  = 0.004) 中更为明显。与怀孕前相比，妊娠早期的 SF 率显着增加，并且在整个样本 ( p  < 0.001) 和 LEV 妇女 ( p  = 0.004)的产后期间持续存在。此外，88.57% 的 SF 女性在孕前和产后期间保持不变。CBZ组1处主要心脏畸形，LTG组和LEV组未发现主要心脏畸形。

结论

与妊娠前相比，妊娠早期出现了更好的临床结果，在接受 GE 和 LEV 治疗的女性中最为明显，强化了妊娠与癫痫发作保护作用的假设。妊娠前 SF 是妊娠期和产后良好临床结果的重要预测因素。与 CBZ 相比，LTG 和 LEV 显示出更好的安全性。