I have had seizures for years. Will it affect my pregnancy?

Question

Hi doctor,

I am a 30-year-old woman who has had seizures since my teenage years, and I have been on medication to control them. My primary concern right now is family planning.

Are my anti-seizure medications safe during pregnancy, or could they harm the baby?
Is it possible that pregnancy itself could trigger more seizures?
I have also noticed that sometimes I get breakthrough seizures just before my periods. Could hormonal changes be causing that?
Should I consider changing medications if I want to conceive?
I am also worried about menopause later in life. Does seizure frequency change with hormone fluctuations at that stage?
Regarding contraception, is an IUD (intrauterine device) a better option for women with seizures, since I have heard that some anti-seizure medicines interfere with hormonal birth control pills?
Could IVF (in vitro fertilization) or fertility drugs increase the risk of seizures?

I feel very anxious because I do not want my condition to stop me from becoming a mother one day.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Many women with epilepsy do go on to have safe pregnancies, but the primary concern is the medication. Some anti-seizure drugs carry a higher risk of birth defects, such as Valproate, while others like Lamotrigine and Levetiracetam are safer. The plan is never to stop medication suddenly but to review with your neurologist before conceiving, so the safest option at the lowest effective dose can be used. Take 5 mg of Folic acid and start well before pregnancy, as it lowers the risk of neural tube defects.

Pregnancy itself can sometimes change seizure frequency. Some women improve, some worsen, and some stay the same. This depends on how stable things are before conception, as well as on factors like sleep deprivation, stress, and drug levels during pregnancy. Breakthrough seizures around periods are a recognized condition called catamenial epilepsy, linked to hormonal fluctuations such as estrogen and progesterone shifts. Hormones do play a role.

Management usually involves adjusting medication rather than a complete change, but this has to be individualized. At menopause, some women notice changes in seizure frequency due to falling estrogen levels, but the pattern is variable. Symptoms may improve or worsen and cannot be predicted. Contraception is another essential consideration.

Many anti-seizure medicines, especially enzyme inducers such as Phenytoin, Carbamazepine, Phenobarbital, and higher doses of Topiramate, can reduce the effectiveness of hormonal pills. This is why IUDs (intrauterine devices), either copper or hormonal, are preferred and considered reliable. IVF (in vitro fertilization) and fertility medicines increase hormone levels, and in some women, they can lower seizure threshold, but IVF is safe. It simply requires close monitoring and medication adjustment if needed.

Preventive measures

Keep a seizure diary, especially around cycles.
Adequate sleep.
Avoid missed doses.
Regular neurology check-up.
Pre-pregnancy counseling is a must.

Please share which anti-seizure medicine you are currently on, as that will help decide if you need a change before pregnancy and what contraception is safest for you.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.