Proactive pre-conception counselling for women with epilepsy-is it effective?

We describe the development of a proactive pre-conception counselling service for women with epilepsy based on complete re-investigation of the woman's epilepsy, a policy of withdrawing antiepileptic drugs (AEDs) thought to carry an increased risk of foetal abnormality (and substitution, where indicated, of AEDs thought to carry a lesser risk) and the exhibition of folic acid 5 mg daily plus fulfilment of the woman's educational needs and exploration of her and her partner's wishes. The outcome of the assessment of 90 such women is compared with the outcome of 59 women presenting to our service already pregnant. An audit of the outcomes in the two groups suggests that re-investigation of women pre-conceptually is worthwhile (some women turn out not to have epilepsy or have cerebral lesions best managed before pregnancy) and that foetal morbidity may be reduced by judicious rationalization of medication: folic acid taken before conception may also be protective for the foetus. Proactive pre-conception counselling, however, only works if the woman is prepared to wait (sometimes up to a year) for necessary drug changes to be instituted and is using reliable contraception.