How to manage epilepsy in women of reproductive age?

Question

Hello doctor,

I am a 31-year-old woman who has had two seizure episodes in the past six months, both involving sudden loss of consciousness and muscle jerking. An MRI of my brain was normal, but my EEG showed abnormal activity.

I am worried about starting anti-seizure medication because I am planning to get pregnant in the next year and have read that some drugs can harm the baby. Are there safer options for women of reproductive age?

Could stress or sleep deprivation be triggering my seizures? I am also concerned about restrictions on driving and working. How do I manage epilepsy without it taking over my life?

Please help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I understand your concern.

Uncontrolled seizures can negatively affect the baby, especially if the frequency of seizure attacks increases during pregnancy. All Women with Epilepsy (WWE) taking Anti-Epileptic Drugs (AEDs) should be advised to take 5 milligrams of folic acid per day before conception and to continue this intake until at least the end of the first trimester to reduce the incidence of major congenital malformations.

Taking 5 milligrams per day of folic acid before pregnancy may also help reduce the risk of anti-epileptic drug-related cognitive deficits. Early pregnancy provides an opportunity to screen for structural abnormalities. A fetal anomaly scan at 18 weeks and 0 days to 20 weeks and six days of gestation can identify major cardiac defects in addition to neural tube defects.

Women with epilepsy and their partners must be informed about the possible adverse impact on the long-term neurodevelopment of the newborn following in utero (in the womb) 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 currently very little evidence regarding Levetiracetam and Phenytoin. Parents should be informed that evidence on long-term outcomes is based on a small number of children.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.