Management of epilepsy in pregnancy

Abstract

Epilepsy is one of the most common chronic neurological conditions, with an estimated 1.2% of the population having an active diagnosis of epilepsy. This makes epilepsy the most frequent major neurological complication in pregnancy. Management strategies for epileptic women wishing to become pregnant mainly involve family planning and counselling. It is important to inform about contraception, the need to plan the pregnancy, the optimization of antiepileptic drugs, folate supplementation and the possible risks of antiepileptic drugs on the fetus, particularly if valproate is used. Epilepsy is not a contraindication to pregnancy and the patient should be instructed that most pregnancies proceed without any problem, and unnecessary worries should be avoided. It must also be reported that contraceptives have interaction with antiepileptics, due to this there is a risk that the effect will be reduced, either that of contraception or the anticonvulsant effect. Ideally, adequate control of epileptic seizures is sought to plan pregnancy, because it has been shown that women who have not had epileptic seizures in the last 9 months will probably not suffer any change in their condition. It is important to know the pharmacokinetics of antiepileptic drugs during pregnancy, monitor their serum levels, and adjust the dose according to the results. With regard to childbirth, epilepsy is not considered a reason for caesarean delivery unless a seizure occurs during labor. The objective of this review is to demonstrate the importance of managing epilepsy during and prior to pregnancy, with emphasis on the care of women with epilepsy in the prenatal, perinatal, delivery and postpartum stages, as well as to demonstrate the potential fetal risks and the management of antiepileptic drugs during pregnancy.