A new risk calculator for pregnant women with epilepsy, developed by researchers from the Queen Mary University of London; has found to accurately predict the risk of seizures during pregnancy and up to six weeks after delivery and could save the lives of mothers and babies. The EMPiRE tool freely available in online to help clinicians identify women at high risk of seizure; inform their care through close monitoring and anti-epileptic drug management.
Women with epilepsy are ten times more likely to die in pregnancy than those without the condition; with seizures as the main cause of death. It has consistently highlighted that the main factor behind these deaths is a lack of recognition; of the women’s high-risk status by health professionals. Pregnant women with epilepsy are advised not to alter their treatment without specialist advice.
The risks of seizures
However, up to four in ten women discontinue their anti-epileptic medication in pregnancy due to concerns about the effects of drugs on the unborn baby; thereby increasing their risks of seizures. Ngawai Moss, 38, has epilepsy and is the mother of two children. “Every woman experiences epilepsy differently in their day to day life but it is a source of worry not knowing when you might have a seizure.
Pregnancy makes you actively question how best to manage your epilepsy. The medication can help prevent seizures, but it can also potentially harmful to the health of the baby. “This dilemma can make the decisions around continuing to take medication during pregnancy difficult. You want to do the right thing for the baby, but it is also important to be practical. If you have a seizure there is a possibility of drowning or sustaining a serious injury; like falling down the stairs which can also harm or kill the baby.
The model uses information which can routinely be collect during an antenatal appointment; such as age at first seizure, type of seizure; seizures in the three months before pregnancy, seizures requiring hospital admission, and current dose of anti-epileptic drugs. It then processes the data to predict the likelihood of seizures not only in pregnancy but up to six weeks after delivery, a period with increased risks to the mother and baby.
Pregnant women with epilepsy
“The EMPiRE tool is the first ever to predict the risk of seizure in pregnant women with epilepsy; who are on anti-epileptic drugs. The model gave accurate predictions regardless of the type of care the woman received, and they are now making it freely available online via a web-based calculator so that any clinician in any part of the world can use it with their patients. By testing the predictive model against the data collected in the study; the team was able to show that the model accurately predicted the risk of seizures.
The model discriminated well between those with and without seizures, with good agreement between predicted and observed risks across both low and high-risk women. The freely available online calculator is aimed at general practitioners; epilepsy specialists, obstetricians, and midwives. “The model will an asset for women living with epilepsy, like me, who are looking to get pregnant or already are. It will help us make informed decisions on how they manage our epilepsy and that in itself is extremely reassuring and empowering.”
“The tool can help pregnant women with epilepsy work with their healthcare team to make empowered; make informed decisions about what is right for them and their treatment during pregnancy and Barts Charity is very proud to support this.” The limitations of the model include that it is mainly applicable to high-income countries due to the source of data it is based upon; its clinical utility is restricted to thresholds above a 12 % risk of seizure; the small validation cohort sample size may have affected the robustness of the external validation.