Grid-Based Preconception Counseling Can Facilitate Shared Decision Making for Women with Epilepsy

Women with epilepsy (WWE) and their care providers are equally concerned about the risk of seizures and adverse effects of using antiepileptic drugs (AED) during pregnancy to the mother and the baby. The risk of death or other complications during the pregnancy period is high when WWE continue to have seizures. Antenatal exposure to valproate and several other AEDs as monotherapy and polytherapy is associated with a higher risk of Major Congenital Malformations (MCM). The risk of MCM is dose dependent for valproate and several other AEDs. Children who were exposed to AEDs in the antenatal period demonstrate impaired intelligence and language functions when examined in early childhood, and this effect endures into the second decade of life also. There is considerable difficulty in communicating the complexities of the benefits and risks of using AEDs during the preconception period and pregnancy to the women and their relatives. In this technical note, we are presenting the grid-based preconception counseling of the risk and benefits of different treatment options to facilitate shared decision making. The clinician elicits the preferences and concerns of WWE in the first column of the grid. The potential outcomes of different treatment options concerning these preferences and concerns are presented in the remaining columns of the grid so that a shared decision can be reached. This option grid provides an opportunity to the WWE to review the options holistically and make appropriate decisions.