Midtveisevaluering - Simone Reiter

Supervisors are Nils Erik Gilhus, Bernt Engelsen and Anne Kjersti Daltveit.

Abstract

Epilepsy: Psychiatric disease and social aspects in women and men with epilepsy during pregnancy.

 Background: Epilepsy is a common disorder, with a life time population prevalence of 0.7-1.0 %. Its etiology is heterogeneous including a broad spectrum of inherited and acquired disorders. Irrespective of primary cause, epilepsy is commonly associated with psychiatric comorbidity, such as depression and anxiety, partly due to accompanying social dysfunction and stigma. With the advent of modern anti-epileptic drugs (AED) the majority of patients with epilepsy become seizure free. Antiepileptic therapy and seizure control may become challenging during pregnancy and the post-partum period however and this may potentiate the psychosocial effects of epilepsy. 

Objectives: We examined the prevalence of mental disorders in women with epilepsy prior to and during pregnancy, and in men with epilepsy during partner’s pregnancy in a large population-based cohort. We also investigated social aspects, quality of life, and self-esteem in the same women and men during pregnancy. Finally we compared groups with and without anti-epileptic drug (AED) treatment, and differences between the epilepsy group and a group with non-neurological chronic disorders.

Methods: The study is based on The Norwegian Mother and Child Cohort Study (MoBa), including self-reported data for the mothers from 106,000 pregnancies, as well as self-reported data from 77,000 partners. Data included 711 women and 658 men with epilepsy. A unique identification number used in both MoBa and the compulsory Medical Birth Registry of Norway made it possible to link the two registries and attain supplementary information from doctors and midwifes.

Results: Epilepsy was associated with risk of depression and eating disorders during and prior to pregnancy in women, and with ADHD and bipolar disorder in men. Adverse social aspects, low satisfaction with life and low self-esteem were also more common in persons with epilepsy. The moderate prevalence of psychiatric disorders in our study compared to previous reports probably reflects improved treatment and follow-up during pregnancy and/or the fact that our cohort was population-based as opposed to hospital-based in other study populations. Young patient age may also play a role as it is generally associated with more active lifestyle and better general health. Women and men with epilepsy who find a partner may be in better health than those who do not.

Conclusion: Our findings show that both AED-treated and untreated women with epilepsy are at risk of depression prior to and during pregnancy. Men with epilepsy are also at higher risk of psychiatric comorbidity during partner’s pregnancy compared to men without epilepsy. We suggest that psychiatric comorbidity should be considered in the follow-up of patients with epilepsy prior to and during pregnancy. This is essential in deciding the optimal AED-treament, avoiding drug interactions, and minimizing side effects. Screening tools for depression, anxiety, and psychosomatic complaints may be effectively used to evaluate psychiatric comorbidity in young women and men with epilepsy.