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Epilepsy and Pregnancy

 

Key Points

  • Over 90% of women with epilepsy have a normal pregnancy.

  • Physicians need to counsel women with epilepsy who are planning a pregnancy about the potential risks such as increased seizure frequency and abnormal/impaired foetal development.

  • If required, appropriate anticonvulsant drugs (ACDs) should be administered at the minimum dose, and plasma level needed to maintain seizure control.

  • Potential problems associated with epilepsy in pregnancy need to be monitored and managed so as to avoid complications and ensure a successful outcome.

 
Guidelines for Counselling

  1. Withdrawal of ACDs should be considered if the patient has been seizure-free for at least 2 years.
  2. If ACDs are indicated, monotherapy should be attempted using the lowest possible dose and plasma level that will control seizures.
  3. The preconception diet should contain adequate folate.
  4. The risk of major and minor malformations and dysmorphic features is 6-8% higher than in mothers without epilepsy.
  5. Maternal and paternal family history should be reviewed for birth defects.
  6. The effects of tonic-clonic seizures may be deleterious to the foetus, injure the mother and can result in miscarriage.
  7. The possibility of prenatal diagnosis with ultrasound and/or amniocentesis for major malformations should be discussed with the mother.

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