Treatment with oxcarbazepine during pregnancy

Managing epilepsy during pregnancy is a critical challenge as maternal seizures may have deleterious effects on the fetus. While many patients with epilepsy have been managed successfully with antiepileptic drugs (AEDs), the potential teratogenicity of AEDs is a major concern. First-generation AEDs such as valproate have been associated with at least a 2-fold risk of fetal malformations compared with the general population. However, recent studies suggest that the newer AEDs given as monotherapy may have a lower teratogenic risk. The current case report adds to the growing experience of oxcarbazepine therapy in pregnant women with epilepsy.

This case report presents a 23-year-old female with a history of complex partial seizures (CPS) and mild depression. In high school, she had 2 initial tonic-clonic seizures and was placed on phenytoin monotherapy. She was subsequently placed on combination therapy (phenytoin + gabapentin) and was maintained on it for several years. Preceding a planned pregnancy, the patient was switched to oxcarbazepine and tapered off both phenytoin and gabapentin. The patient was maintained on oxcarbazepine monotherapy with a seizure-free pregnancy and delivered a normal, healthy baby girl. The patient breast-fed the infant for 6 months, supplemented with infant formula without any adverse effects. Subsequently, the patient has had a healthy second child while receiving oxcarbazepine during her pregnancy.

Although there are very limited data in the literature, this case illustrates that a patient with a history of CPS can be treated with oxcarbazepine with no adverse effects during and after pregnancy.