Epilepsy in pregnancy- Introduction

• Epilepsy causes greater challenge to women at every major phase of life adolescence reproductive
age menopause.

• Goal - focused on improved quality of life rather than mere control of seizures.

• Neurologists Obstetricians are increasingly faced with challenge of women with epilepsyWWE during
pregnancy

• Pregnancy influences the natural history of epilepsy pharmacodynamics kinetics of anti-epileptic drugs
AED in a diverse manner.

• These women need integrated care of neurologist obstetrician other specialists.

• "Counter to previous dogma women with epilepsy are not at a substantially increased risk for
cesarean section late pregnancy bleeding or premature contractions or delivery.

If woman is seizure-free 9 months before pregnancy very likely that she will continue to remain seizure-
free throughout pregnancy and who not had seizure for 2-5 years may attempt complete withdrawal
from AEDs prior to conception.

• Most need to continue medication during pregnancy as uncontrolled seizures can be harmful while on
antiepileptic drugs have an increased risk to fetus . Because exposure to multiple AEDs seems to be
more teratogenic than monotherapy patients are advised to switch to a single AED prior to conception
and to taper to the lowest possible dose.

• An attempt to switch to one of the newer AEDs might offer lower fetal/embryonic risk although this
has not been studied in a prospective randomized clinical trial.

Definition and incidence

• Epilepsy in pregnancy is defined as a paroxysmal disorder of central nervous system with an abnormal
neuronal discharge with or without loss of consciousness.

• Epilepsy complicates 1 in 200 pregnancies.

Epilepsy is the most commonly encountered serious neurological problem in obstetrical practice.

The disease and treating medications may have significant impact on contraceptive choice, efficacy and
reproduction. During pregnancy, the obstetricians, neurologists and primary care physicians have the
unenviable task of ensuring freedom from seizures during pregnancy while minimizing possible adverse
effects of AEDs on the fetus and maximizing the opportunity for a good outcome for the mother and the
newborn. The purpose of this article is to provide an update on management of women with epilepsy
before and during pregnancy, and in the postpartum period, paying particular attention to the areas
where GP care is involved.
Conclusion

While managing a pregnant woman with epilepsy, general practitioners play a pivotal part in the three-
way communication that occurs between the obstetrician, neurologist and themselves. It is therefore
necessary to have up-to-date information about the disease and its management during pregnancy.
With the advent of pregnancy AED registries and landmark research studies, information is available
regarding various AEDs, their effects on the fetus, and harm minimisation without compromising
maternal health.