Treatment options for pregnant women with epilepsy

Abstract

Background: Antiepileptic drugs (AEDs) in pregnancy are associated with an increased risk of fetal malformations. Concern is expressed about the effects that AEDs may produce on the child's cognition and development. To date, no specific malformations have clearly been proven to be attributable to a specific drug, with the exception of valproate. Objective: In order to gain prospective data, collaborative pregnancy registers have been established which collect data on teratogenicity and seizure control efficacy of AEDs, and on the comparative efficacy of second-generation AEDs. Methods: Studies of the effects of AED exposure on cognitive function have begun. Future head-to-head studies of traditional and newly developed AEDs may provide a more rational basis for defining first and second line choices of medications for women with epilepsy generally, and more specifically in pregnancy. Conclusions: Traditional prescribing patterns appear to influence the options for treatment of women with epilepsy in pregnancy, which is then adjusted according to the variability of response.

Keywords::

• anticipation of pregnancy
• cognitive effects
• epilepsy syndrome
• folate
• monotherapy
• pharmacotherapy
• seizures
• traditional and second generation antiepileptic drugs
• teratogenicity
• vitamin supplements