Epilepsy is a common illness and therefore, we commonly encounter women with epilepsy (WWE), who are either pregnant or contemplating pregnancy. There are a lot of apprehensions and misconceptions regarding managing epilepsy in this group of WWE. Here, I wish to highlight some of the important aspects of managing epilepsy in women who are planning pregnancy or are currently pregnant.
1. If a woman is seizure-free for at least two years, she can consider withdrawing anti-epileptic drugs (AEDs) under the supervision of neurologist, and then plan for pregnancy.
2. If a woman has seizures, it is better to continue AEDs during pregnancy, as the risk to the baby is several times higher with seizures, as compared to that with AEDs.
3. Sodium valproate has the highest risk to the developing baby, and it should be avoided in pregnancy.
4. AEDs such as levetiracetam, lamotrigine, oxcarbazepine, topiramate, etc are safe and may be continued during pregnancy.
5. The lowest effective dose of AED should be used.
6. Try to use only a single anti-epileptic drug, if possible.
7. Folic acid vitamin supplements should be used in pregnancy.
8. The dose of anti-epileptic medication may have to be increased during the last three months of pregnancy.
9. CT scan of brain should be avoided, as far as possible, during pregnancy, as radiation exposure due to it may harm the baby.
10. MRI brain is reasonably safe for baby, especially after the first three months of pregnancy. So, if needed, it may be performed.