[Epilepsy and pregnancy (review of the literature)]

The relationship between pregnancy and epilepsy has often been object of particular attention and care by many epileptologists. The aim of this survey of the literature is to give an up-to-date and comprehensive review of this relation and to focalize the many related problems which still are unsolved. The following principal chapters are discussed: 1) the influence of pregnancy on epilepsy; 2) the influence of epilepsy on pregnancy and delivery; 3) the influence of epilepsy on newborns; 4) the teratogenic effects of antiepileptic medication. Many conflicting data make it very difficult to summarize the results, however it is clear that the effect of pregnancy on seizure frequency may be quite variable. Seizures, in fact, during pregnancy may be increased, decreased or remain unchanged. The most conflicting data are those related to the effects of epilepsy on pregnancy and delivery, while concordant opinions indicate an increased perinatal mortality and morbidity in offsprings of epileptic women. Special attention has to be payed to the offsprings of epileptic mothers. The presence of congenital abnormalities in fact, is about 2 times higher for newborns of mothers with epilepsy than for offsprings of mothers without the disease. Another important problem is related to the presumed teratogenicity of antiepileptic drugs. It has not yet been demonstrated that antiepileptic compounds have a teratogenic effect on offsprings. However it has been shown that this assumption is often associated to a higher presence of congenital malformations. The majority of malformations (facial clefts and heart defects) occur in association with the use of trimethadione, phenobarbital, primidone and acetazolamide, whereas they are much less frequent in association with phenytoin, carbamazepine, valproate.