Checklist for Women

Checklist for Women with Epilepsy - Printable version

 Physician Discussion Checklist for Women with Epilepsy
Prepared by the American Epilepsy Society, Practice Committee, September 2008 
Adapted from "Checklist for Discussions with Your Doctor", epilepsy.com

For all Women, Adolescents, and Pre-teens during Reproductive Years

  • Relationship between hormones and epilepsy (overview)
  • Possible menstrual cycle-related influence on seizure susceptibility (catamenial epilepsy)
  • Impact of epilepsy on sexual and on reproductive issues
  • Epilepsy is rarely related to infertility (consult infertility specialist if there is a sign of difficulty conceiving, test for PCOS)
  • Relation of some AEDs to libido and potency problems
  • Women with epilepsy CAN become pregnant with or without AEDs; importance of pregnancy planning including folate supplementation; need for effective and consistent contraception to avoid unplanned pregnancy
  • Effective contraception choices (interactions between hormonal contraception and certain AEDs; possible contraceptive failure and need to consider barrier method for added protection
  • Other forms of contraception (patch, IUD, Depo-Provera)
  • Need to inform neurologist if contraception is discontinued
  • Need for calcium supplementation and vitamin D for bone health
  • Optimal seizure control and AED choices should be achieved a minimum of 6 months before attempting to conceive
  • Folic acid supplementation recommendation for all women with child bearing potential.  The optimal dose of folate is not known but at least 1 mg/day up to 4 mg/day with the exception of valproic acid when 4 mg/day is recommended.  

Women Planning to Conceive

Note: Confirm the diagnosis of epilepsy and seizure type.  In all discussions, emphasize the balance of all risks and the goal of controlling seizures

  • Optimal seizure control and AED choices should be achieved a minimum of 6 months before attempting to conceive
  • Need for folate supplementation in all women of with child bearing potential.  The optimal dose of folate is not known but at least 1 mg/day up to 4 mg/day with the exception of valproic acid when 4 mg/day is recommended.
  • Healthy pregnancies and healthy babies are the goal
  • Need for optimum seizure control
  • All risks (women not taking AEDs also have risks)
  • Risks to the baby from AEDs must be balanced with risk of seizures to baby and mother
  • Ways to reduce risks to mother and baby (AED choices; folate supplementation)
  • Appropriate AED medication/need to optimize before pregnancy; importance of NOT making any changes without neurology consultation (maintaining good compliance)
  • Identify an obstetrician comfortable treating a woman with epilepsy
  • How pregnancy can affect seizure frequency and severity
  • Fertility treatments and possible effects on AED levels and seizure susceptibility

Pregnant  Women 

Note: Confirm the diagnosis of epilepsy and seizure type.  In all discussions, emphasize the balance of all risks and the goal of controlling seizures

  • Consultation with patient’s obstetrician ________________(date) 

For patients who never received pre-pregnancy planning:

  •  For patients who never had pre-conception counseling, discussion of AEDs and multiple AEDs on outcome, risks of AEDs vs. Seizures, Timing of major malformations to first trimester.
  •  Possible teratogenic effects compared to people not taking an AED
  • Possible change in AED therapy (only in consultation with neurologist) 

Review of pregnancy management by trimester:

First Trimester

  • Have high resolution ultrasound first and second trimester
  • Continue folic acid
  • Changes in serum AED concentration in pregnancy and need for close monitoring of blood levels, serum levels of once per month recommended during pregnancy.
  •  AED management with severe emesis 

Second Trimester

  •  Continue folic acid
  • Changes in serum AED concentration in pregnancy and need for close monitoring of blood levels, serum levels of once per month recommended during pregnancy 

Third Trimester

  • Vitamin K recommendations for mother before delivery and for baby
  • Changes in serum AED concentration in pregnancy and need for close monitoring of blood levels, serum levels of once per month recommended during pregnancy 

Labor and Delivery

  •  Need to bring AEDs to the hospital during labor and to take regular doses 

Post-partum

  •  AED dose adjustment following delivery and post-partum follow-up
  • Breast feeding: discussion of risks from AEDs balanced against known benefits of breast feeding
  • Maintaining adequate sleep for mother
  • Safety for the newborn (changing on floor or bed, bathing, carrying up stairs)
  • Newborn appointment for neurologist evaluation (age 4-6 weeks)
  • Parenting issues to maximize safety for the newborn including minimizing mother’s fatigue to avoid seizure exacerbation and home safety preparation  

Women Beyond Childbearing Years

  • Bone health and need for calcium supplementation and bone density monitoring seizure control to prevent falls
  • Peri-menopause effects on seizures/AEDs
  • Menopause/hormone replacement issues; enzyme-inducing effects of hormones on AEDs