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Toprani S, Meador KJ, Robalino CP, Brown CA, Matthews AG, Gerard EE, Penovich P, Gedzelman E, Cavitt J, Hwang ST, Kalayjian LA, Sam M, Pack A, Pennell PB. Effect of Epilepsy on Sleep Quality During Pregnancy and Postpartum. Neurology 2022; 99:e1584-e1597. [PMID: 35853745 PMCID: PMC9559942 DOI: 10.1212/wnl.0000000000200959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/25/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study seeks to understand how sleep is affected in pregnant women with epilepsy (WWE) relative to healthy pregnant women during pregnancy and postpartum and to nonpregnant WWE during comparative periods. Sleep affects maternal health and mood during pregnancy. Maternal sleep disturbances are related to poor fetal growth and increased fetal deaths. Epilepsy is the most common neurologic condition in pregnancy. Sleep disruption can worsen epileptic seizures. The interplay between epilepsy, pregnancy, and sleep is poorly understood. METHODS The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an NIH-funded, prospective, observational, multicenter study, enrolling women from December 2012 through January 2016. Sleep quality was assessed using the average Pittsburgh Sleep Quality Index collected during pregnancy, postpartum, or analogous periods. Sleep scores range from 0 to 21 with higher scores indicating worse sleep quality; scores >5 are associated with poor sleep quality. RESULTS Of 351 pregnant WWE, 105 healthy pregnant women, and 109 nonpregnant WWE enrolled in the MONEAD study, data from 241 pregnant WWE, 74 healthy pregnant women, and 84 nonpregnant WWE were analyzed. Pregnant WWE had worse sleep (a higher mean sleep score) during pregnancy compared with healthy pregnant women in unadjusted analysis (p = 0.006), but no longer significant in adjusted analysis (p = 0.062); pregnant WWE (least square mean sleep score [95% CI] = 5.8 [5.5-6.1]) vs healthy pregnant women (5.1 [4.6-5.7]). During postpartum period, WWE (5.6 [5.4-5.9]) had similarly impaired sleep compared with healthy women (5.7 [5.2-6.2]; adjusted p = 0.838). Sleep was significantly worse in pregnant WWE vs nonpregnant WWE (for comparable period) in pregnancy and postpartum in unadjusted and adjusted analyses; adjusted scores for pregnant WWE in pregnancy (5.7 [5.4-6.0]) and those in postpartum (5.7 [5.4-6.0]) compared with those for nonpregnant WWE (4.7 [4.2-5.3]; p = 0.002) and (4.1 [3.6-4.7]; p < 0.001), respectively. Sleep quality between pregnancy and postpartum varied only in healthy pregnant women (change in mean score = 0.8 [0.2-1.3]; p = 0.01), whose sleep was worse in postpartum. DISCUSSION Pregnant WWE had worse sleep during pregnancy and postpartum period than nonpregnant WWE during comparable periods in the adjusted analysis. TRIAL REGISTRATION INFORMATION The study is registered at ClinicalTrials.gov as NCT01730170.
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Affiliation(s)
- Sheela Toprani
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA.
| | - Kimford J Meador
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Chelsea P Robalino
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Carrie Anne Brown
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Abigail G Matthews
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Elizabeth E Gerard
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Patricia Penovich
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Evan Gedzelman
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Jennifer Cavitt
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Sean T Hwang
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Laura A Kalayjian
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Maria Sam
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Alison Pack
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
| | - Page B Pennell
- From the Stanford University (S.T., K.J.M.), Palo Alto, CA; Emmes (C.P.R., C.A.B., A.G.M.), Rockville, MD; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; Northwell Health (S.T.H.), New Hyde Park, NY; University of Southern California (L.A.K.), Los Angeles; Wake Forest University Health Sciences (M.S.), Winston-Salem, NC; Columbia University (A.P.), New York; and University of Pittsburgh Medical Center (P.B.P.), PA
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Bath KG, Scharfman HE. Impact of early life exposure to antiepileptic drugs on neurobehavioral outcomes based on laboratory animal and clinical research. Epilepsy Behav 2013; 26:427-39. [PMID: 23305780 PMCID: PMC3925312 DOI: 10.1016/j.yebeh.2012.10.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 10/30/2012] [Indexed: 12/13/2022]
Abstract
Epilepsy affects approximately 1% of children under the age of 15, making it a very common neurological disorder in the pediatric population (Russ et al., 2012). In addition, ~0.4-0.8% of all pregnant women have some form of epilepsy (Hauser et al., 1996a,b; Borthen et al., 2009; Krishnamurthy, 2012). Despite the potential deleterious effects of antiepileptic drugs (AEDs) on the developing brain, their use is still required for seizure control in pregnant women (Krishnamurthy, 2012), and they represent the standard approach for treating children with epilepsy (Chu-Shore and Thiele, 2010; Quach et al., 2010; Verrotti et al., 2011). Even when AEDs are effective, there are potential side effects, including cognitive and affective changes or altered sleep and appetite. The consequences of AED exposure in development have been studied extensively (Canger et al., 1999; Modi et al., 2011a,b; Oguni, 2011). Despite intensive study, there is still debate about the long-term consequences of early life AED exposure. Here, we consider the evidence to date that AED exposure, either prenatally or in early postnatal life, has significant adverse effects on the developing brain and incorporate studies of laboratory animals as well as those of patients. We also note the areas of research where greater clarity seems critical in order to make significant advances. A greater understanding of the impact of AEDs on somatic, cognitive and behavioral development has substantial value because it has the potential to inform clinical practice and guide studies aimed at understanding the genetic and molecular bases of comorbid pathologies associated with common treatment regimens. Understanding these effects has the potential to lead to AEDs with fewer side effects. Such advances would expand treatment options, diminish the risk associated with AED exposure in susceptible populations, and improve the quality of life and health outcomes of children with epilepsy and children born to women who took AEDs during pregnancy.
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Affiliation(s)
- Kevin G. Bath
- Department of Neuroscience, Brown University, Box GL-N, 185 Meeting St., Providence, RI 02912, USA,Corresponding author. (K.G. Bath)
| | - Helen E. Scharfman
- The Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Bldg. 35, Orangeburg, NY 10962, USA,New York University Langone Medical Center, 550 First Ave., New York, NY 10016, USA
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