How to manage epilepsy triggered after childbirth in a woman?

Question

Hello doctor,

I am really scared because my 28-year-old niece was diagnosed with epilepsy after having her first seizure four months postpartum. She was breastfeeding when the seizure happened and dropped the baby, who thankfully was not hurt.

The neurologist put her on Levetiracetam 750 mg twice daily, but she is having terrible mood swings and crying spells, which are making postpartum depression worse. She had to stop breastfeeding because of the seizure medication, which broke her heart.

EEG showed spike activity in the left temporal lobe, and MRI was normal. She has had three more seizures despite being on medication, and each time they seem to last longer. The epilepsy specialist wants to add Lamotrigine, but warned that it might interact with her birth control pills.

She desperately wants to have more children, but is scared of seizure control during pregnancy. Her husband works night shifts, and she is terrified of having a seizure while alone with the baby. Sleep deprivation in the newborn seems to trigger seizures more frequently. Blood levels of Levetiracetam are therapeutic, but she is still breaking through.

Can epilepsy be triggered by hormonal changes after pregnancy? She really needs better seizure control so she can take care of her baby safely.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Yes, it can affect the baby if the seizure is uncontrolled and the frequency of seizures increases during pregnancy. All women taking antiepileptic drugs should be advised to take 5 mg per day of folic acid prior to conception and to continue the intake until at least the end of the first trimester to reduce the incidence of major congenital malformations.

Pre-pregnancy folic acid, five milligrams per day, may be helpful in reducing the risk of antiepileptic drug-related cognitive deficits. Early pregnancy can be an opportunity to screen for structural abnormalities. The fetal anomaly scan at 18 weeks 0 days to 20 weeks six days of gestation can identify major cardiac defects in addition to neural tube defects.

Women with epilepsy and their partners need to be informed about the possible adverse impact on long-term neurodevelopment of the newborn following in utero exposure to Sodium Valproate.

Based on limited evidence, in utero exposure to Carbamazepine and Lamotrigine does not appear to adversely affect the neurodevelopment of the offspring. There is very little evidence for Levetiracetam and Phenytoin. Parents should be informed that evidence on long-term outcomes is based on small numbers of children.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.