Abstract
Epilepsy is a chronic neurological condition that requires treatment throughout the pregnancy. Seizures should be well controlled before conception with a specific type of anti-epileptic drug (AED) for each epileptic syndrome. The selection of AED is crucial in women with epilepsy (WWE). AEDs with the lowest malformations rates should be used for treatment during pregnancy. Valproate should be avoided in WWE of childbearing age as it is associated with the highest risk of neurocognitive malformations. However, pregnancy might alter the levels of AEDs, which can lead to an increase in seizure frequency. It is important to monitor AED levels and make necessary dose adjustments to control seizures during pregnancy. WWE should be treated with the lowest possible dose allowed and preferably with a single AED to avoid harmful effects on the developing fetus. Women should be counseled to take folic acid during pregnancy as it reduces the risks for cardiovascular, genitourinary, and neural tube defects. Generally, WWE usually have normal pregnancies and can bear healthy offspring. Pregnant women need continuous follow-up in a coordinated manner with the neurologist and obstetrician to assess for adverse pregnancy and fetal outcomes.
Highlights
BackgroundEpilepsy is a chronic disorder that affects the general population, with an annual incidence rate of 40-70 per 100,000 persons per year [1]
We will discuss the impact of physiological changes during pregnancy, changes in anti-epileptic drug (AED) levels, alterations in seizure frequency, the malformation risks of different AEDs, the effect of epilepsy on the general health of women with epilepsy (WWE), the optimal management of epilepsy, and which drugs are considered safe during pregnancy
Results from data of the EURAP, North American Antiepileptic Drug Pregnancy Registry (NAAPR), and UK Epilepsy & Pregnancy Register showed that valproate is associated with the highest rates of abnormalities, whereas carbamazepine and Lamotrigine are associated with moderately increased risk. [9,11,13] we will discuss briefly individual AED and types of malformation associated with each drug
Summary
Epilepsy is a chronic disorder that affects the general population, with an annual incidence rate of 40-70 per 100,000 persons per year [1]. The North American Antiepileptic Drug Pregnancy Registry (NAAPR) that enrolled more than 3,000 WWE and on AEDs has reported malformation rates of monotherapy for valproate to be highest 9.3%, followed by phenobarbital (5.5%), topiramate (4.2%), carbamazepine (3%), phenytoin (2.9%), levetiracetam (2.4%), and lamotrigine (2.0%) (Table 4) [11]. Results from data of the EURAP, NAAPR, and UK Epilepsy & Pregnancy Register showed that valproate is associated with the highest rates of abnormalities, whereas carbamazepine and Lamotrigine are associated with moderately increased risk. With reference to other observational studies as well, valproate must be avoided for seizure control in WWE of childbearing age to avoid malformations in fetus development and to prevent learning disabilities Another retrospective study was conducted in regional epilepsy clinics in Manchester and Liverpool in the UK to study the long-term outcome of children born to mothers with epilepsy. (8) Most of the WWE generally have a vaginal delivery, and the mode of delivery can be decided according to obstetric indications rather than epilepsy itself [27]
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