Epilepsy and Pregnancy: Current Recommendations and Management Challenges

Karthik Varma^*
*Correspondence: Karthik Varma, Department of Biomedical Sciences, Osmania University, Hyderabad, Telangana, India, Email:

Keywords

Neurological disorder • Epilepsy • Antiepileptic drugs

Introduction

Epilepsy is one of the most common neurological conditions that can coexist with pregnancy. Recent estimates suggest that approximately one in every 250 pregnant women has epilepsy. Epilepsy does not usually impede fertility; however, the interaction between epilepsy, Antiepileptic Drugs (AEDs), and pregnancy can be complex.

The main goal of epilepsy management in pregnant women is twofold: maintaining the mother’s health by controlling seizures and safeguarding the health of the unborn child [1,2].

Ideally, this should take place prior to conception. This is a crucial opportunity to reassess the woman’s seizure control, discuss the potential risks of AEDs to the fetus, and consider necessary modifications to the treatment regimen. It also provides a platform for discussing the importance of taking high-dose folic acid supplements to reduce the risk of neural tube defects.

Minimizing the number of AEDs is recommended, if possible. Monotherapy is preferred over polytherapy, as it generally carries a lower risk of congenital malformations. Among the AEDs, lamotrigine and levetiracetam are widely considered as first-line drugs for use in pregnancy due to their relatively lower risks [3].

Regular antenatal monitoring is advised. This may include more frequent ultrasound scans to check for fetal anomalies and monitoring AED plasma levels, which can fluctuate during pregnancy. Vitamin K Supplementation: In the last month of pregnancy, vitamin K supplementation is recommended to prevent hemorrhagic disease of the newborn, especially if the mother is taking enzyme-inducing AEDs.

Achieving an optimal balance between maintaining maternal seizure control and ensuring fetal safety is often a delicate juggling act.

Pregnancy induces several physiological changes that can alter the pharmacokinetics of AEDs, leading to lower drug levels and potentially, breakthrough seizures. Regular monitoring and dose adjustments are often necessary [4].

Literature Review

There is growing concern about the potential impact of in-utero AED exposure on the child's neurodevelopment. More longitudinal studies are needed to further elucidate these risks.

Approximately half of all pregnancies are unplanned, making preconception counselling difficult in many cases. Ensuring that all women of childbearing age with epilepsy are aware of the potential issues is a crucial public health task. Managing epilepsy in pregnancy is a complex process that requires individualized patient management. Despite the numerous challenges, with adequate planning, monitoring, and care, most women with epilepsy can expect to have a healthy pregnancy and deliver a healthy baby. Further research is ongoing to ensure that these women and their healthcare providers have the best evidence to guide their decisions [5].

The postpartum period brings a new set of challenges. Women with epilepsy (WWE) are at an increased risk of postpartum depression, which necessitates screening and appropriate management. Sleep deprivation, common in the first few months of parenthood, can precipitate seizures, so finding strategies to ensure adequate rest is vital.

Discussion

The issue of breastfeeding while on AEDs often arises. The benefits of breastfeeding generally outweigh the potential risks of trace amounts of AEDs, and it is usually encouraged. However, the infant should be monitored for possible side effects, such as excessive sleepiness or poor feeding. Special consideration should be given to the type of AED, as some drugs have higher levels in breast milk than others. The management of epilepsy in pregnancy is undoubtedly complex and requires a multidisciplinary approach. Neurologists, obstetricians, and paediatricians must work together to provide comprehensive care. Each woman's circumstances and epilepsy type are unique, demanding an individualized approach to her treatment [6]. There's an increasing trend towards shared decision-making, where the woman is actively involved in discussions regarding her care. Patient education is fundamental to this process. Tools such as online resources and decision aids can be valuable in enhancing a woman's understanding of the issues at hand and enabling her to make informed choices.

There are still many unanswered questions in this field. Further research is needed to determine the safest AEDs, to fully understand the long-term effects of in utero AED exposure on a child's neurodevelopment, and to develop strategies to minimize these potential risks. Large-scale, multicentre, prospective studies, such as the on-going Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study, are yielding valuable insights. Other promising areas of research include the development of new AEDs with safer profiles in pregnancy and the exploration of non-pharmacological interventions for epilepsy.

Conclusion

Managing epilepsy in pregnancy can be challenging but with careful planning, monitoring, and individualized treatment, these challenges can be effectively met. Key to this is the collaboration between healthcare providers and the woman herself, underpinned by an ethos of shared decision-making. As we move forward, continued research will undoubtedly shed more light on this complex area, improving outcomes for both mother and child.

Acknowledgement

None.

Conflict of Interest

None.

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