Seizure, and pregnancy

Posted On April 23, 2020

Woman who are in child bearing age or desire to get pregnant needs special consideration in using anticonvulsant (antiepileptic drug = AED). The following is a very short synopsis, please refer to numerous full review for information.

Before getting pregnant

  • AED interfere with birth control pills, may result in contraceptive failure. especially the enzyme induction medications such as:
    • Carbamazepine, Oxycarbazepine
    • Phenobarbital, Primidone
    • Phenytoin
  • 50 percent of pregnancies are unplanned
  • Need to establish diagnosis, reassess need for AED
    • Seizure type, true seizure vs psychogenic nonepileptic seizure (PNES)
  • 98% of drugs approved for human use including OVER THE COUNTER drugs has potential teratogenic effect. Smoking, alcohol, mariajuna also cause adverse effect on fetus.
  • Optimize AED: Monotherapy with lowest dose if possible.
  • AED risk profile, from low to high
    • First line: Monotherapy with Lamotrigine (LTG) or Levetiracetam (LEV). If possible keep LTG < 325 mg/day
    • Second line: Carbamazepine (CBZ), oxcarbazepine (OXC), zonisamide (ZNS)
    • Third line: Phenytoin (PHT), phenobarbital (PB), topiramate (TPM)
    • Do NOT use valproic (VPA)
  • Teratogenic risks is also dose dependent
  • Start Folic acid
    • 1 mg qd
    • high risk group: 4 mg qd

During pregnancy

  • Pregnancy may cause increased seizure
    • Avoid sleep deprivation
    • Emphasize AED compliance
    • Regular OB care
    • Continue folic acid
  • AED
    • Pregnancy increases metabolism of AED
    • Check level every 4 – 6 weeks, or if recurrent seizure
    • Adjust dose
  • Seizure during pregnancy
    • Check for eclampsia
    • If imaging study needed: Consider MRI, avoid contrast
    • LTG: takes weeks to titrate to therapeutic dose, does not come in iv form
    • LEV: may be the only option

During delivery

  • Pain management
  • If recurrent seizure, iv Lorazepam

Post partum

  • Follow up level, taper down AED
  • Avoid sleep deprivation
  • Safety precaution with the newborn
    • Hold baby only in bed, not when standing.
    • Do not sleep with baby
    • Do not bath baby alone
    • Do not drive.
  • Breastfeeding
    • All AED will be secreted in milk