Current anti-epileptic treatment in women of childbearing age

Abstract

The treatment of epilepsy in women of childbearing age requires special considerations. Pregnancies should ideally be planned allowing for appropriate treatment adjustments before conception. The prescribing physician therefore needs to be aware of the pharmacokinetic interactions between enzyme-inducing anti-epileptic drugs (AED) and oral contraceptives, and also of the effect of estradiol-containing contraceptives on lamotrigine. The pharmacological treatment of epilepsy during pregnancy aims at controlling generalized tonic-clonic seizures with minimized exposure to potentially teratogenic drugs. Research has shown differences between AED in their teratogenic potential. Whereas, valproate has been associated with greater risks for malformations and adverse effects on cognition than carbamazepine and lamotrgine, the teratogenic risks with the latter two AED appears to be limited. Risks appear to increase with the dose. Our knowledge of the safety of other newer AED is still insufficient. The teratogenic risks should be balanced against the need for seizure control, which can be challenging, as serum concentrations of AED might be affected by pregnancy. This is most pronounced for lamotrigine, but is also relevant for other AED. The general strategy is to select the most appropriate AED for the individual woman taking efficacy as well as teratogenic potential into account and to try out, before conception, the lowest effective dose. Once this has been established, it is recommended to measure the serum concentration of the drug that will serve as a reference for drug concentrations obtained during pregnancy. After delivery, breast-feeding can usually be recommended. © 2013 Japanese Society of Neurology and Wiley Publishing Asia Pty Ltd.