[Epilepsy and pregnancy]

Based on recent international consensus conferences and a literature search, a brief summary is given of current knowledge about epilepsy in pregnancy. We suggest new Norwegian guidelines based on international recommendations for handling pregnant women with epilepsy. There is a slightly increased risk for malformations in children born of women with epilepsy. The main reason is probably teratogenic effects of antiepileptic drugs. Nevertheless, the overall chance of giving birth to a healthy child is 92-96%, compared to about 98% in the general population. Counselling all fertile women with epilepsy is important in order to reduce the risk of malformations. Before a planned pregnancy, medication should be re-evaluated, and the lowest dose of the drug most likely to give satisfactory seizure control is preferable. The women should have regular neurological follow-up throughout the pregnancy, and they should be given extra vitamin D, K, and folate. Women using carbamazepine, valproate or the new generation of antiepileptic drugs should be offered amniocentesis and comprehensive ultrasound examination in the 14th and 17th week, respectively. The newly approved drugs should be prescribed only if they provide a considerable better seizure control and/or fewer side effects than the traditional antiepileptic drugs.