Pregnancy and epilepsy

Abstract

Women with epilepsy who become pregnant are often of significant concern to both neurologists and non-neurologists alike. It is important to understand the pharmacokinetic changes that occur with pregnancy to ensure proper dosing of antiseizure medication. Preconceptional counseling and supplementation with folate are essential to mitigate risks to both mother and fetus during development, especially in the first trimester. Usage of antiseizure medication involves preparation prior to pregnancy to achieve seizure freedom and minimize risk from exposure to antiseizure drugs that are known to carry higher risk of teratogenicity, such as valproate or phenobarbital. Further, the optimal management of pregnant women includes antiseizure drugs that limit unnecessary exposure to polytherapy and high doses of antiseizure medication where possible. Additional management of seizure risk factors that can lead to aggravation of seizures such as ensuring avoidance of sleep deprivation and non-adherence are important issues to discuss during routine clinic visitation.