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Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Optimizing treatment of epilepsy during pregnancy

From the Kuopio Epilepsy Center, Department of Neurology, Kuopio University Hospital, Kuopio, Finland (Dr. Kälviäinen) and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (Dr. Tomson).

Address correspondence and reprint requests to Dr. Reetta Kälviäinen, Kuopio Epilepsy Center, Department of Neurology, University Hospital of Kuopio, PO Box 1777, 70211 Kuopio, Finland; e-mail: reetta.kalviainen{at}kuh.fi

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.

This supplement has been supported through an unrestricted grant from UCB S.A., manufacturers of levetiracetam (Keppra®).

Disclosure: Dr. Kälviäinen has received speaker and consultancy fees from the sponsor of this supplement. Dr. Tomson has received a grant from the sponsor of this supplement.

Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represents the opinions of the authors and is not endorsed by nor does it reflect the views of the American Academy of Neurology, Editorial Board, Editor-in-Chief, or Associate Editors of Neurology.

This article has been cited by other articles:

				S. Karceski Epilepsy and pregnancy: Are seizure medications safe? Neurology, September 30, 2008; 71(14): e32 - e33. [Full Text] [PDF]

				T. Tomson and V. Hiilesmaa Epilepsy in pregnancy BMJ, October 13, 2007; 335(7623): 769 - 773. [Full Text] [PDF]