title: Drug-resistant focal epilepsy in women of childbearing age: Reproduction and the effect of epilepsy surgery.
abstract: Women with epilepsy (WWE) have lower birth rates than expected. The reasons for this are multifactorial and involve a complex interaction between reproductive endocrine and psychosocial factors. The effect of epilepsy surgery on reproduction in women with drug-resistant focal epilepsy has not previously been studied.
  
  
  
  Adult women of childbearing age (18-45years old) with drug-resistant focal epilepsy who had undergone a focal cortical resection between 1997 and 2008 at the Mayo Clinic in Rochester, MN were included in the study. Patients who had a history of hysterectomy or tubal ligation or who were menopausal at the time of surgery were excluded. Data on prior pregnancies and births, epilepsy history, surgical treatment, hormonal dysfunction, and socioeconomic status were obtained using a retrospective chart review. Associations between various clinical and demographic variables with changes in pregnancies and births from pre- to postsurgery were assessed using Chi-square or Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. All tests were 2-sided, and p-values less than 0.05 were considered statistically significant. All analyses were performed using SAS software version 9.2 (SAS INC, Cary NC).
  
  
  
  One hundred and thirteen women (average age: 30.5years) were included in the study. Average length of follow-up was 5.7years (SD-3.90). Sixty-four patients (57.5%) were nulliparous at the time of surgery. Sixty-one patients (54%) had never been married. Average number of pregnancies per patient prior to surgery was 0.93, and average number of births prior to surgery was 0.73. After surgery, a total of 17 women had a total of 35 pregnancies and 25 births. The average number of pregnancies and births after surgery was 1.27 and 0.96, respectively. Infertility was reported in one patient postoperatively. Patients who were younger at the time of surgery experienced a greater change in the number of pregnancies and births after surgery (p=0.0036 and 0.0060, respectively). Patients who received fewer antiepileptic drug medication trials by the time of surgery also had a greater change in the number of births after surgery (p=0.0362). Seizure onset localization and lateralization, presurgical seizure frequency, age at seizure onset, duration of epilepsy, and postoperative seizure outcome were not statistically significant factors.
  
  
  
  The present retrospective observational study provides additional evidence for the importance of early surgical treatment in women with drug-resistant focal epilepsy. Patients who had received fewer medications prior to surgery were more likely to experience an increase in births following surgery. The significance of these findings requires further investigation but may support a role for earlier surgical intervention in the management of drug-resistant focal epilepsy.
authors.affiliation: Mayo Clinic, Division of Epilepsy, Department of Neurology, Rochester, MN, United States.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Fabris
authors.affiliation: Comfort Home Health Care, Rochester, MN, United States.
authors.forename: Teresa Griffin
authors.initials: TG
authors.lastname: Cascino
authors.affiliation: Mayo Clinic, Department of Health Sciences Research, Rochester, MN, United States.
authors.forename: Jay
authors.initials: J
authors.lastname: Mandrekar
authors.affiliation: Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States.
authors.forename: W Richard
authors.initials: WR
authors.lastname: Marsh
authors.affiliation: Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States.
authors.forename: Frederic B
authors.initials: FB
authors.lastname: Meyer
authors.affiliation: Mayo Clinic, Division of Epilepsy, Department of Neurology, Rochester, MN, United States.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Cascino
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000601:surgery; D000069279:Drug Resistant Epilepsy / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000150:complications; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011247:Pregnancy; D012098:Reproduction; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014930:Women; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Drug-resistant focal epilepsy; Focal cortical resection; Pregnancy; Women with epilepsy