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Author Notes:

Corresponding Author: Kimford J. Meador, MD, FAAN, FRCPE, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford Neuroscience Health Center, 213 Quarry Road, MC 5979, Palo Alto, CA 94304-5979, Tel: 650-725-6648, Fax: 650-721-4865, kmeador@stanford.edu.

The investigators thank the children and families who have given their time to participate in the MONEAD Study.

The authors thank all the members of the MONEAD Study Group for their contributions

Please see publication for full list of disclosures.

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Research Funding:

This work was supported by NIH NINDS, NICHD #U01-NS038455 (Meador, Pennell) and U01-NS050659 (May).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Behavioral Sciences
  • Clinical Neurology
  • Psychiatry
  • Neurosciences & Neurology
  • Pregnancy
  • Epilepsy
  • Seizures
  • Antiepileptic drugs
  • AUSTRALIAN REGISTER
  • VALPROATE
  • EXPOSURE
  • OUTCOMES
  • RISK

Changes in antiepileptic drug-prescribing patterns in pregnant women with epilepsy

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Journal Title:

Epilepsy and Behavior

Volume:

Volume 84

Publisher:

, Pages 10-14

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: We analyzed current prescribing patterns for antiepileptic drugs (AEDs) in pregnant women with epilepsy (PWWE) at 20 USA tertiary epilepsy centers. Methods: The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an NIH-funded, prospective, observational, multicenter investigation of pregnancy outcomes for both mother and child, which enrolled women from December 2012 to January 2016. Inclusion criteria for PWWE included ages 14–45 years and up to 20 weeks gestational age. Exclusion criteria included history of psychogenic nonepileptic spells, expected intelligence quotient (IQ) < 70, other major medical illness, progressive cerebral disease, and switching AEDs in pregnancy prior to enrollment. Results: Three hundred fifty-one PWWE were enrolled in the MONEAD study, which included 259 (73.8%) on monotherapy, 77 (21.9%) on polytherapy, and 15 (4.3%) on no AEDs. The most common AED monotherapy regimens were lamotrigine (42.1% of monotherapies), levetiracetam (37.5%), carbamazepine (5.4%), zonisamide (5.0%), oxcarbazepine (4.6%), and topiramate (3.1%). All other individual monotherapies were each < 1%. The most common AED polytherapy combination was lamotrigine + levetiracetam (42.9% of polytherapies), followed by lacosamide + levetiracetam (6.5%), lamotrigine + zonisamide (5.2%), and all other remaining combinations (each < 4%); only 5.2% of polytherapy subjects were on ≥ 3 AEDs (1.1% of total PWWE). Only four subjects (1.1%) were on valproate (1 monotherapy, 3 polytherapy). Conclusions: The distribution of AED use likely reflects current prescribing patterns for PWWE cared for in USA tertiary epilepsy centers. This distribution has changed markedly since the turn of the century, but changes in the general population remain uncertain.

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© 2018 Elsevier Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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