Optimizing treatment of epilepsy during pregnancy

Freedom from seizures is the ultimate goal in treatment of patients with epilepsy. At the same time, the side effects of antiepileptic drugs (AEDs) should not outweigh the benefits of treatment. This is particularly important in women with epilepsy who wish to become pregnant. These women and their partners should be made aware of the risks associated with uncontrolled seizures as well as the teratogenicity of some AEDs. Recent studies have indicated a higher risk for birth defects and possibly also adverse cognitive effects associated with exposure to valproate compared with carbamazepine. Although further studies are needed, it appears reasonable to use valproate with caution in women with epilepsy who are planning to become pregnant and to consider whether other equally effective and safer AEDs are available. However, women who need valproate to control their seizures should continue the drug and not be discouraged from pregnancy, provided that they receive counseling with the best available knowledge. With proper management before conception, during pregnancy, and after birth, the vast majority of pregnancies in women with active epilepsy will have a favorable outcome.