WED 033 Minimum prevalence of non-compliance recorded in an audit of antenatal care in a district general hospital joint obstetric epilepsy

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Epilepsy is among the leading indirect causes of death in pregnancy. A retrospective case review of 143 DGH patients with seizures (50 Idiopathic Generalised, 72 Focal 19 Dissociative) seen in a joint obstetric neurology antenatal clinic from 2015–2017 was undertaken. Systematic data collection was not possible owing to the retrospective nature of the audit, however, salient findings were: Of the cohort of 143, 25 were not taking any AED at booking (around 12 weeks). Of those on AEDs over 80% were on lamotrigine or Levetiracetam monotherapy. Most (87/143) had been seizure free pre-conception for at least 1 year. 11 of this group had breakthrough seizures. AED levels were checked on 57 patients (Lamotrigine – 48:Levetiracetam 9) and were undetectable in 10/57 (17.5%) at booking. Reasons for AED testing refusal and non-concordance (when present) were unknown. Of 11 patients losing seizure control during pregnancy 3 were non-concordant at booking.ConclusionNon concordance at booking was documented in 1 in 6. Loss of previous seizure control occurred in 11/87 (12.6%) of previously seizure free patients of whom 3/11 were nonconcordant. AED monitoring revealed significant non-concordance and may relate to subsequent loss of seizure control. A prospective study is planned.

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