Focus on women and epilepsy

Practice Parameter update: Management issues for women with epilepsy – focus on pregnancy (an evidence-based review) Author:  Cynthia Harden, M.D., et al. 

These new guidelines developed by the American Academy of Neurology and the American Epilepsy Society show the relative safety for women with epilepsy to become pregnant, but caution against taking one particular epilepsy drug, which can cause birth defects.  The guidelines were published in the April 27, 2009 online issue of the journals Epilepsia  and  Neurology    

Practice Parameter update: Management issues for women with epilepsy—focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeedingReport of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society  

Practice Parameter update: Management issues for women with epilepsy—focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomesReport of the Quality Standards Subcommittee and Therapeutics and TechnologySubcommittee of the American Academy of Neurology and American Epilepsy Society 

Practice Parameter update: Management issues for women with epilepsy—focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequencyReport of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society  

  • The new guidelines are part of the American Epilepsy Society’s ongoing collaboration with the American Academy of Neurology to keep doctors who treat epilepsy patients informed on practice issues based upon  current clinically relevant research.
  • These guidelines on women and pregnancy are important and will have a major impact on women with epilepsy who are pregnant or plan to become pregnant.
  • The guidelines recommend that women with epilepsy avoid taking valproate during pregnancy, and that avoidance of phenytoin and phenobarbital also be considered.
  • If possible, more than one anticonvulsant should not be taken during pregnancy to reduce the risk of birth defects compared to taking one medication.
  • Overall, the guidelines show that women with epilepsy are not at a substantially increased risk of premature birth or complications associated with labor and delivery.
  • If a woman is seizure free nine months before she becomes pregnant, she will likely be seizure free during the pregnancy. 
  • Drug blood levels tend to decrease during pregnancy.  Regular blood tests and dose adjustments can maintain levels in the effective range and keep women seizure free.
  • Women with epilepsy who plan to have children should speak with their doctors before becoming pregnant.           

  To view the guidelines go to www.aan.com/go/practice/guidelines.

Epilepsy Update: A Case Series (A CME Activity)
Long-term Consequences of AED Exposure During Pregnancy
Autumn M. Klein, M.D., PhD.
Harvard Medical School