Is a safe pregnancy possible with a seizure disorder?

Question

Hi doctor,

My 27-year-old niece had her first seizure three weeks ago while at work, and I am really worried about her. She was at her desk and suddenly started shaking all over; her coworkers called an ambulance.

The ER doctor said it was a generalized tonic-clonic seizure. Her CT scan and MRI came back normal, but the EEG showed some abnormal activity. The neurologist wants to start her on seizure medication, but she is hesitant because she and her husband are trying to get pregnant.

They have been trying for eight months already with no success. She is scared that taking seizure medications will cause birth defects if she gets pregnant.

Her doctor mentioned the importance of folic acid and that some medications are safer than others during pregnancy. However, she is also concerned about the possibility of having another seizure while pregnant, which seems dangerous too.

Her mother had seizures when she was younger, but grew out of them. Is this condition hereditary? I am also wondering if her intense work stress triggered the first seizure; she works 60-hour weeks. Can she live a normal life with a seizure disorder and still have children?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

If a seizure becomes uncontrolled and occurs frequently during pregnancy, it can affect the baby.

Women taking antiepileptic drugs should be advised to take 5 mg of Folic acid daily prior to conception and continue this dosage until at least the end of the first trimester. This can help reduce the risk of major congenital malformations.

Taking Folic acid at a dose of 5 mg per day may also help decrease the risk of cognitive deficits associated with antiepileptic drugs (AEDs).

Early in pregnancy is an ideal time to screen for structural abnormalities. The fetal anomaly scan, conducted between 18 and 20 weeks of gestation, can identify major cardiac defects along with neural tube defects.

Women who are pregnant and their partners should be aware of the potential long-term neurodevelopmental impacts on the newborn associated with in utero exposure to sodium valproate.

Current evidence suggests that in utero exposure to Carbamazepine and Lamotrigine does not appear to adversely affect the neurodevelopment of the offspring, and there is very little information regarding levetiracetam and phenytoin. However, Sodium valproate has been linked to the risk of neural tube defects and cardiac defects.

I hope this explanation clarifies the situation.

If you have any questions or require further assistance at any time, please do not hesitate to contact us. We are here to help.

Thank you.