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Epilepsy
1Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, United States.
Handbook of Clinical Neurology
|August 10, 2020
Summary
Managing epilepsy in pregnancy requires careful planning. Optimizing antiseizure medications (ASMs) and using folic acid before conception improves outcomes for both mother and baby.
Area of Science:
- Neurology
- Obstetrics
- Pharmacology
Background:
- Epilepsy management during pregnancy balances maternal seizure control with fetal well-being.
- Preconception counseling is crucial for optimizing outcomes.
Purpose of the Study:
- To provide guidance on managing epilepsy in pregnant women.
- To highlight the importance of preconception counseling and medication management.
Main Methods:
- Review of current literature and clinical guidelines.
- Emphasis on preconception optimization of antiseizure medications (ASMs).
- Monitoring of ASM levels during pregnancy and postpartum counseling.
Main Results:
- Folic acid supplementation reduces neural tube defect risk and may improve cognitive outcomes.
- Valproic acid is associated with significant risks of congenital malformations and neurodevelopmental issues.
- Seizure control is vital, as convulsive seizures pose risks to fetal development.
Conclusions:
- Optimizing ASM regimens before pregnancy, avoiding teratogenic agents like valproic acid, and regular monitoring are key.
- Effective communication between obstetric and neurology providers is essential.
- Breastfeeding is generally encouraged, with benefits outweighing medication transmission risks.
Keywords:
Antiseizure medicationEpilepsyFolic acidLamotrigineMajor congenital malformationSeizureValproic acidMore Related Videos
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