Managing the Risks Associated with Pregnancy in Epileptic Women

Abstract

Normal pregnancy outcome is expected in most women with epilepsy (WWE). Pre-pregnancy counseling should focus on educating the patient about her disease, controlling her seizure with the most appropriate and lowest possible dose of Anti-Epileptic Drug (AED) is the key to the successful maternal outcome in WWE. Prenatal care should ideally be provided by joint epilepsy obstetric clinic. On analyzing data from epilepsy pregnancy registers from various national registers it is evident that newer AEDs like lamotrigine and levetiracetam are associated with a lower risk of major congenital malformations. Sodium valproate and topiramate appear to carry an alleviated risk of major congenital malformation and should only be used in WWE of reproductive age group if seizures are not controlled on other AED’s. Lamotrigine and levetiracetam have evolved as first-line drugs in the management of WWE. Although trials on a larger number of cases are needed to validate the results. The purpose of this article is to provide an update on the management of WWE prior to and during pregnancy. In the article information is presented concerning seizure frequency in pregnancy, effects of epileptic seizure on the fetus occurrence of complications during pregnancy and delivery, the incidence of fetal congenital malformations, effect on intrauterine growth, infant developmental and behavioral outcome.