Management and outcome of Pregnant Patients with Epilepsy Associated with Cerebral Cavernous Malformations
LynnMarie Jarratt1, Lauren Hatcher1, Daniel Barnett1, Iffat Ara Suchita1, Annapoorna Bhat1
1University of New Mexico School of Medicine
Objective:
To review seizure and pregnancy outcomes of pregnant patients with Cerebral Cavernous Malformations (CCM) in New Mexico population
Background:
Cerebral Cavernous Malformations (CCMs) are inherited or sporadic dilated capillary tangles within the brain that may present as intracranial hemorrhages, seizures, or intractable headaches. Data is scant in regards to the specific management of pregnant women with epilepsy (WWE) with known CCMs. Some available literature reports similar pregnancy outcomes to those without CCMs with unchanged rates of the above-mentioned complications. Our retrospective case series investigates the pregnancy and birthing outcomes of four female patients diagnosed with CCMs and epilepsy for contribution to the growing literature of management in this specific population.
Design/Methods:
Electronic medical records of four WWE and comorbid CCMs were retrospectively analyzed with attention to comparisons between their pre and perinatal epilepsy burden and CCM characteristics. Childbirth delivery outcomes were also obtained.
Results:
All four women (23-28 years old) were found to have no worsening epilepsy control during pregnancy in comparison to their pre-pregnancy seizure burden, though one patient had two breakthrough seizures in the setting of transitioning from Clobazam to Keppra. No hemorrhages were reported during pregnancy in any of the patients. Three of the four women had an uncomplicated vaginal delivery and one had an elective C-section per obstetric concerns for possible hemorrhage during normal delivery or induction.
Conclusions:
The outcomes shown by our case study support the trends of stable CCM and epilepsy courses during pregnancy as outlined by some current literature. Pregnant women with CCMs have similar rates of hemorrhage expansion and seizure frequency as compared to the non-pregnant state, supporting the notion that the presence of CCMs with epilepsy is not a contraindication to pregnancy and the majority of women can have successful vaginal deliveries.
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