The management of epilepsy during pregnancy is crucial because both seizures and antiepileptic drugs (AEDs) can pose risks to the fetus. The goal is to balance effective seizure control with the safety of the fetus.
In Australia, as in many other countries, the choice of AED during pregnancy is based on the individual’s seizure type, the effectiveness of the medication, and its safety profile during pregnancy. Here are some considerations and commonly used antiepileptic medications in the context of pregnancy (LLC)
- Lamotrigine (Lamictal): Considered one of the safer options during pregnancy, lamotrigine is frequently used for various seizure types. There’s a need for careful monitoring, as pregnancy can affect lamotrigine levels.
- Levetiracetam (Keppra): Another AED considered relatively safe during pregnancy. It’s used for various seizure types, and like lamotrigine, requires careful monitoring of levels during pregnancy.
- Carbamazepine (Tegretol): An older AED that’s still commonly used. There are concerns about the risk of fetal malformations, especially neural tube defects, but it might be recommended if it’s particularly effective for the individual.
Avoid
- Phenytoin (Dilantin): While less commonly used as a first-line agent due to concerns about cleft lip and palate, it might be continued if a woman is well-controlled on it and if changing medications poses significant risks.
- Valproate (Valproic Acid, Epilim): It’s associated with a higher risk of fetal malformations, including neural tube defects and cognitive impairment. In general, valproate is avoided in women of childbearing potential unless there’s no alternative. If a woman is on valproate and considering pregnancy, a thorough discussion with her neurologist is essential.
- Other AEDs: There are many other antiepileptic drugs, such as topiramate (Topamax), zonisamide (Zonegran), and others. The safety profiles of newer AEDs during pregnancy are still being understood, so decisions regarding their use often depend on individual circumstances.
General Recommendations for Managing Epilepsy in Pregnancy:
- Pre-conception Counseling: Women with epilepsy should consult their neurologist and obstetrician before becoming pregnant to discuss medication choices and risks.
- Folate Supplementation: To reduce the risk of neural tube defects, higher doses of folate (e.g., 5 mg daily) are often recommended for women taking AEDs before conception and during the first trimester.
- Regular Monitoring: AED levels can change during pregnancy, potentially affecting seizure control and the safety of the fetus. Regular monitoring and dose adjustments may be needed.
- Vitamin K Supplementation: Some AEDs can affect vitamin K metabolism. Supplementing with vitamin K in the last month of pregnancy can help prevent hemorrhagic disease of the newborn.
- Delivery Plans: Women with epilepsy should discuss delivery plans, including how to manage medications during labor and potential risks associated with seizures during labor.
- Postpartum Management: After delivery, medication adjustments may be needed, and considerations for breastfeeding should be discussed.
The management of epilepsy during pregnancy requires a multidisciplinary approach, involving neurologists, obstetricians, and other healthcare professionals. The key is individualized care, ensuring the best outcomes for both mother and baby.