Epilepsy in Women




Smarter Medical Care show

Summary: Women with epilepsy looking to get pregnant can be safely taken through pregnancy with a very high probability of a normal fetus, and no increase in problems to the Mom as well. To increase the chances of a normal baby, it may mean changing medicines to the newer, safer drugs for a period of at least 6 months before trying to get pregnant to make sure the new medicines prevent seizures. Women with epilepsy do have additional problems. Compared to other women, women with epilepsy can have endocrine problems such as higher rates of infertility, irregular cycles and sexual dysfunction. Should these problems exist, there are anti-seizure medicines that can minimize these problems. When choosing to get pregnant, women must also consider the effects of the anti-seizure medicines on babies. Women with epilepsy can expect to have normal babies but there is a slightly higher risk of having certain problems in their baby. Many of these problems in the baby are mild but some can be quite severe. The risk from Mom’s epilepsy to have any of these problems is perhaps twice the non-epileptic pregnant women. The risk to the baby exists because the Mom has epilepsy and may be further increased by certain anti-seizure medicines. For this reason, some medicines –like valproate and barbiturates – are avoided completely. Women can also have a higher risk of migraines, mood problems and depression. There are specialty clinics at hospitals where there are epilepsy specialists as well as groups who care for people with high risk pregnancies. The threat to the baby from Mom having a seizure is higher than the threat of birth defects so that the proper choice of anti-seizure medicines throughout the pregnancy is important. The first line drugs for women thinking of or in fact pregnant are Kepra, Tegretol and Lomictil. Pregnant women with seizures also need counseling about breast feeding. Most of the medicines are put into Mom’s milk if there is breast feeding and the newer ones do not make the baby sleepier. Mom’s may need Vitamin K, especially at the end of the pregnancy while on older anti-seizure medicines. All women need folate in pregnancy. During pregnancy, women will gain weight, retain fluids and have changes in hormones that can change the amount of anti-seizure medicines they need as the pregnancy progresses. Therefore, they need to have blood levels of the anti-seizure medicines during the pregnancy. When delivery is near, the anesthesiologist needs to know about the seizure problem and keep Mom well hydrated. Epilepsy is almost always not inherited. It’s the same risk as the general population though one of the problems of any complicated delivery is seizures.