Seizure medication and planned pregnancy: balancing the risks and outcomes

References

• Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy. A systematic review and meta-analysis of international studies. Neurology. 2017;88(3):296–303.
   PubMed Web of Science ®Google Scholar
• Beghi E. The epidemiology of epilepsy. Neuroepidemiology. 2020;54(Suppl. 2):185–191.
   PubMed Web of Science ®Google Scholar
• Banerjeea PN, Filippi D, Hauser WA. The descriptive epidemiology of epilepsy-A review. Epilepsy Res. 2009;85(1):31–45.
   PubMed Web of Science ®Google Scholar
• Hu Y, Shan Y, Du Q, et al. Gender and socioeconomic disparities in global burden of epilepsy: an analysis of time trends from 1990 to 2017. Front Neurol. 2021;12:art643460.
   Web of Science ®Google Scholar
• Gooneratne IK, Wimalaratna S. Update on management of epilepsy in women for the non neurologist. Postgrad Med J. 2016;92(1091):554–559.
   PubMed Web of Science ®Google Scholar
• Olafsson E, Hallgrimsson JT, Hauser WA, et al. Pregnancies of women with epilepsy: a population-based study in Iceland. Epilepsia. 1998;39(8):887–892.
   PubMed Web of Science ®Google Scholar
• Tomson T, Battino D. Teratogenic effects of antiepileptic drugs. Lancet Neurol. 2012;11(9):803–813.
   PubMed Web of Science ®Google Scholar
• Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE commission for classification and terminology. Epilepsia. 2017;58(4):522–530.
   PubMed Web of Science ®Google Scholar
• Elavarasi A, Parihar J, Kapoor S, et al. Seizure-related injuries in inadequately treated epilepsy patients: a case-control study. Seizure. 2020;83:17–20.
   PubMed Web of Science ®Google Scholar
• Willems LM, Watermann N, Richter S, et al. Incidence, risk factor and consequences of epilepsy-related injuries and accidents: a retrospective, single center study. Frontiers Neurol. 2018; 9: art.414. 10.3389/fneur.2018.00414
   Web of Science ®Google Scholar
• de Boer H, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav. 2008;12(4):540–546.
   PubMed Web of Science ®Google Scholar
• Sveinsson O, Andersson T, Mattsson P, et al. Clinical risk factors in SUDEP A nationwide population-based case-control study. Neurology. 2020;94(4):e419–e429.
   PubMed Web of Science ®Google Scholar
• Sveberg L, Svalheim S, Taubøll E. The impact of seizures on pregnancy and delivery. Seizure. 2015;28:35–38.
   PubMed Web of Science ®Google Scholar
• Christensen J, Vestergaard C, Bech BH. Maternal death in women with epilepsy. Smaller scope studies. Neurology. 2018;91:e1716–e1720.
   Google Scholar
• Edey S, Moran N, Nashef L. SUDEP and epilepsy-related mortality in pregnancy. Epilepsia. 2014;55(7):e72–e74.
   PubMed Web of Science ®Google Scholar
• MacDonald SC, Bateman BT, McElrath TF, et al. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol. 2015;72(9):981–988.
   PubMed Web of Science ®Google Scholar
• Shahla M, Hijran B, Sharif M. The course of epilepsy and seizure control in pregnant women. Acta Neurol Belg. 2018;118(3):459–464.
   PubMed Web of Science ®Google Scholar
• Pennell PB, Peng L, Newport DJ, et al. Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70(22):2130–2136.
   PubMed Web of Science ®Google Scholar
• Mostacci B, Troisi S, Bisulli F, et al. Seizure worsening in pregnancy in women with sleep-related hypermotor epilepsy (SHE): a historical cohort study. Seizure. 2021;91:258–262.
   PubMed Web of Science ®Google Scholar
• Abe K, Hamada H, Yamada T, et al. Impact of planning of pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and neonatal outcomes. Seizure. 2014;23(2):112–116.
   PubMed Web of Science ®Google Scholar
• Tomson T, Battino D, Bonizzoni E, et al., Withdrawal of valproic acid treatment during pregnancy and seizure outcome: observations from EURAP. Epilepsia. 57(8): e173–1737This. 2016. .
   PubMed Web of Science ®Google Scholar
• Vajda FJE, O’Brien TJ, Graham JE, et al. Pregnancy after valproate withdrawal-Fetal malformations and seizure control. Epilepsia. 2020;61(5):944–950.
   PubMed Web of Science ®Google Scholar
• Harden CL, Hopp J, Ting TY, et al. Practice parameter update: management issues for women with epilepsy–Focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency report of the quality standards subcommittee and therapeutics and technology assessment subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73(2):126–132.
   PubMed Web of Science ®Google Scholar
• Vajda FJE, Hirchcock A, Graham J, et al. Seizure control in antiepileptic drug-treated pregnancy. Epilepsia. 2008;49(1):172–175.
   PubMed Web of Science ®Google Scholar
• Karlsson Lind L, Komen J, Wettermark B, et al. Valproic acid utilization among girls and women in Stockholm: impact of regulatory restrictions. Epilepsia Open. 2018;3(3):357–363.
   PubMedGoogle Scholar
• PRAC recommends strengthening the restrictions on the use of valproate in women and girls. European Medicines Agency. Available at: www.ema.europa.eu/en/news/pracrecommends-strengthening-restrictions-use-valproate-women-girls [Accessed date: 11 December 2018]
   Google Scholar
• Medicines related to valproate: risk of abnormal pregnancy outcomes. GOVUK Available at: www.gov.uk/drug-safety-update/medicines-related-to-valproate-risk-ofabnormal-pregnancy-outcomes [accessed December 7, 2018]
   Google Scholar
• Sisodiya SM, Epilepsy Advisory Group for the Association of British Neurologists. Valproate and childbearing potential: new regulations. Pract Neurol. 2018;18(3):176–178.
   PubMedGoogle Scholar
• New measures to avoid valproate exposure in pregnancy endorsed. European Medicines Agency. Available at: www.ema.europa.eu/en/news/new-measures-avoidvalproate-exposure-pregnancy-endorsed [Accessed date: 7 December 2018]
   Google Scholar
• CMDH grees to Strengthen Warnings on the Use of Valproate Medicines in Women and Girls, 2014. Available at: ww.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2014/11/news_detail_002220.jsp&mid=WC0b01ac058004d5c1 [Accessed December 2, 2014]
   Google Scholar
• Glauser T, Ben-Menachem E, Bourgeois B, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013;54(3):551–563.
   PubMed Web of Science ®Google Scholar
• Epilepsies: diagnosis and management. Guidance and guidelines NICE. Available at www.nice.org.uk/guidance/cg137. [ Accessed date: 16 January 2019].
   Google Scholar
• Angus-Leppan H, Liu RSN. Weighing the risks of valproate in women who could become pregnant. BMJ. 2018;361:k1596.
   PubMedGoogle Scholar
• Giuliano L, La Neve A, Galimberti CA, et al. Valproate and female patients: prescribing attitudes of Italian epileptologists. Epilepsy Behav. 2019;97:182–186. DOI:10.1016/j.yebeh.2019.05.024
   PubMed Web of Science ®Google Scholar
• Battino D, Tomson T, Bonizzoni E, et al. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013;54(9):1621–1627.
   PubMed Web of Science ®Google Scholar
• Mole TB, Appleton R, Marson A. Withholding the choice of sodium valproate to young women with generalised epilepsy: are we causing more harm than good? Seizure. 2015;24:127–130.
   PubMed Web of Science ®Google Scholar
• Wu M, Hao N, Yan B, et al. Status epilepticus in pregnant women with epilepsy after valproate adjustment: a case series. Seizure. 2016;43:39–41.
   PubMed Web of Science ®Google Scholar
• Knight M, Bunch K, Tuffnell D et al. . . Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17 Oxford (National Perinatal Epidemiology Unit, University of Oxford). 2019.
   Google Scholar
• Nei M, Daly S, Liporace J. A maternal complex partial seizure in labor can affect fetal heart rate. Neurology. 1998;51(3):904–906.
   PubMed Web of Science ®Google Scholar
• Sahoo S, Klein P. Maternal complex partial seizure associated with fetal distress. Archives of Neurology. 2005;62(8):1304–1305.
   PubMedGoogle Scholar
• LaJoie J, Moshe SL. Effects of seizures and their treatment on fetal brain. Epilepsia. 2004;45(suppl8):48–52.
   PubMedGoogle Scholar
• Nulman I, Laslo D, Koren G. Treatment of epilepsy in pregnancy. Drugs. 1999;57(4):535–544.
   PubMed Web of Science ®Google Scholar
• Zahn C. Neurologic care of pregnant women with epilepsy. Epilepsia. 1998;39(suppl8):S26–S31.
   PubMedGoogle Scholar
• Minkoff H, Schaffer RM, Delke I, et al. Diagnosis of intracranial hemorrhage in utero after a maternal seizure. Obstet Gynecol. 1985;65(suppl):22S24S.
   Google Scholar
• Burnett C. A survey of the relation between epilepsy and pregnancy. J Obstet Gynecol. 1946;53:539–556.
   Google Scholar
• Hiilesmaa V, Teramo K. Fetal and maternal risks with seizures. In: Harden C, Thomas SV, Tomson T, et al., editors. Epilepsy in women Wiley-Blackwell (Wiley). 2013. p. 115–127.
   Google Scholar
• Yerby MS, Devinsky O. Epilepsy and pregnancy. In: Devinsky O, Feldmann E, Hainline B, editors. Advances in neurology: neurological complications of pregnancy. New York NY: Raven Press; 1994. p. 45–63.
   Google Scholar
• Laskowska M, Leszczynska-Gorzelak B, Oleszczuk J. Pregnancy in women with epilepsy. Gynecol Obstet Invest. 2001;51(2):99–102.
   PubMed Web of Science ®Google Scholar
• Viale L, Allotey J, Cheong-See F, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet. 2015;386(10006):1845–1852.
   PubMed Web of Science ®Google Scholar
• Yerby M, Koepsell T, Daling J. Pregnancy complications and outcomes in a cohort of women with epilepsy. Epilepsia. 1985;26(6):631–635.
   PubMed Web of Science ®Google Scholar
• Viinikainen K, Heinonen S, Eriksson K, et al. Community-based, prospective, controlled study of obstetric and neonatal outcome of 179 pregnancies in women with epilepsy. Epilepsia. 2006;47(1):186–192.
   PubMed Web of Science ®Google Scholar
• Chen YH, Chiou HY, Lin HC, et al. Effect of seizures during gestation on pregnancy outcomes in women with epilepsy. Arch Neurol. 2009;66(8):979–984.
   PubMedGoogle Scholar
• Borthen I, Eide MG, Daltveit AK, et al. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. Bjog. 2011;51:2058–2065.
   Google Scholar
• Jenabi E, Bashirian S, Asali Z, et al. Association between small for gestational age and risk of autism spectrum disorders: a meta-analysis. Clin Exp Pediatr. 2021;64(10):538–542.
   PubMedGoogle Scholar
• Adab N, Kini U, Vinten J, et al. The longer term outcome of children born to mothers with epilepsy. J Neurol Neurosurg. 2004;75(11):1575–1583.
   PubMed Web of Science ®Google Scholar
• Meador KJ, Baker GA, Browning N, et al., Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 12(3): 244–252. 2013.
   PubMed Web of Science ®Google Scholar
• Baker GA, Bromley RL, Briggs M, et al. IQ at 6 years after in utero exposure to antiepileptic drugs: a controlled cohort study. Neurology. 2015;84(4):382–390.
   PubMed Web of Science ®Google Scholar
• EUROCAT Guide 1.3. Instructions for the registration of congenital anomalies. EUROCAT Central Registry, University of Ulster; 2005.
   Google Scholar
• Meadow RW. Anticonvulsant drugs and congenital abnormalities. Lancet. 1968;292(7581):1296.
   Google Scholar
• Hernandez-Diaz S, Smith CR, Shen A, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78(21):1692–1699.
   PubMed Web of Science ®Google Scholar
• Campbell E, Kennedy F, Russell A, et al. Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland epilepsy and pregnancy registers. J Neurol Neurosurg. 2014;85(9):1029–1034.
   PubMed Web of Science ®Google Scholar
• Tomson T, Battino D, Bonizzoni E, et al. EURAP: an international registry of antiepileptic drugs and pregnancy. Epilepsia. 2004;45(11):1463–1464.
   PubMed Web of Science ®Google Scholar
• Tomson T, Battino D, Perucca E. Teratogenicity of antiepileptic drugs. Curr Opin Neurol. 2019;32(2):246–252.
   PubMed Web of Science ®Google Scholar
• Tomson T, Battino D, Bonizzoni E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. Lancet Neurol. 17(6): 530–538. 2018.
   PubMed Web of Science ®Google Scholar
• Greenberg RG, Melloni C, Wu H, et al. Therapeutic index estimation of antiepileptic drugs: a systematic literature review approach. Clin Neuropharmacol. 2016;39(5):232–240.
   PubMed Web of Science ®Google Scholar
• Karlovassitou-Koniari A, Alexiou D, Angelopoulos P, et al. Low dose sodium valproate in the treatment of juvenile myoclonic epilepsy. J Neurol. 2002;249(4):396–399.
   PubMed Web of Science ®Google Scholar
• Pietrafusa N, La Neve A, de Palma L, et al. Juvenile myoclonic epilepsy: long-term prognosis and risk factors. Brain Dev. 2021;43(6):688–697.
   PubMed Web of Science ®Google Scholar
• Hunt S, Russell A, Smithson WH, et al. Topiramate in pregnancy: preliminary experience from the UK epilepsy and pregnancy register. Neurology. 2008;22(71):272–276.
   Google Scholar
• Hernandez-Diaz S, Huybrechts KF, Desai RJ, et al. Topiramate use early in pregnancy and the risk of oral clefts: a pregnancy cohort study. Neurology. 2018;90(4):e342–e351.
   PubMed Web of Science ®Google Scholar
• Veroniki AA, Cogo E, Rios P, et al. Comparative safety of antiepileptic drugs during pregnancy: a systematic review and network meta-analysis of congenital malformations and prenatal outcomes. BMC Med. 2017;15(1):95.
   PubMedGoogle Scholar
• Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology. Epilepsia. 2017;58(4):512–521
   PubMed Web of Science ®Google Scholar
• Medicines. European Medicines Agency. 2020. accessed October 3, https://www.ema.europa.eu/en/medicines
   Google Scholar
• National registers of authorised medicines. European medicines agency. Available at: www.ema.europa.eu/en/medicines/national-registers-authorised-medicines [accessed October 3, 2020]
   Google Scholar
• Vazquez B, Tomson T, Dobrinsky C, et al. Perampanel and pregnancy. Epilepsia. 2021;62(3):698–708.
   PubMed Web of Science ®Google Scholar
• Alicino AM, Falcicchio G, Boero G, et al. Perampanel during pregnancy: description of four cases. Epilepsy & Behavior Reports. 2021;16:100490.
   PubMedGoogle Scholar
• McCluskey G G, Kinney MO, Russell A, et al. Zonisamide safety in pregnancy: data from the UK and Ireland epilepsy and pregnancy register. Seizure. 2021;91:311–315.
   PubMed Web of Science ®Google Scholar
• Holmes LB, Mittendorf R, Shen A, et al. Fetal effects of anticonvulsant polytherapies: different risks from different drug combinations. Arch Neurol. 2011;68(10):1275–1281.
   PubMed Web of Science ®Google Scholar
• Wilson J. Embryotoxicity of Drugs in Man. In: Wilson JG, Fraser FC(eds). General Principles and Etiology . Boston, MA: Springer.1977;309-355.
   Google Scholar
• Sadler TW. Birth defects and prenatal diagnosis, chapter 9. In: editor, Sadler TW. Langman’s medical embryology. 13th edn ed. Philadelphia: Lippincott Williams & Wilkins; 2015;117–129.
   Google Scholar
• Feldkamp ML, Botto LD, Carey JC. Reflections on the etiology of structural birth defects: established teratogens and risk factors. Birth Defects Res. Part A, Clin Mol Teratol. 2015;103(8):652–655.
   PubMedGoogle Scholar
• Meador KJ, Baker GA, Browning N, et al. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. N Engl J Med. 2009;360(16):1597–1605.
   PubMed Web of Science ®Google Scholar
• Christensen J, Grønborg TK, Sørensen MJ, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013;309(16):1696–1703.
   PubMed Web of Science ®Google Scholar
• Deshmukh U, Adams J, Macklin EA, et al. Behavioral outcomes in children exposed prenatally to lamotrigine, valproate, or carbamazepine. Neurotoxicol Teratol. 2016;54:5–14.
   PubMed Web of Science ®Google Scholar
• Viinikainen K, Eriksson K, Mönkkönen A, et al. The effects of valproate exposure in utero on behavior and the need for educational support in school‐aged children. Epilepsy Behav. 2006;9(4):636–640.
   PubMed Web of Science ®Google Scholar
• Vinten J, Bromley RL, Taylor J, et al. The behavioral consequences of exposure to antiepileptic drugs in utero. Epilepsy Behav. 2009;14(1):197–201.
   PubMed Web of Science ®Google Scholar
• Cohen MJ, Meador KJ, Browning N, et al. Fetal antiepileptic drug exposure: motor, adaptive, and emotional/behavioral functioning at age 3 years. Epilepsy Behav. 2011;22(2):240–246.
   PubMed Web of Science ®Google Scholar
• Cohen MJ, Meador KJ, Browning N, et al. Fetal antiepileptic drug exposure: adaptive and emotional/behavioral functioning at age 6 years. Epilepsy Behav. 2013;29(2):308–315.
   PubMed Web of Science ®Google Scholar
• Rihtman T, Parush S, Ornoy A. Developmental outcomes at preschool age after fetal exposure to valproic acid and lamotrigine: cognitive, motor, sensory and behavioral function. Reprod Toxicol. 2013;41:115–125.
   PubMed Web of Science ®Google Scholar
• Bromley RL, Calderbank R, Cheyne CP, et al. Cognition in school‐age children exposed to levetiracetam, topiramate, or sodium valproate. Neurology. 2016;87(18):1943–1953.
   PubMed Web of Science ®Google Scholar
• Rasalam AD, Hailey H, Williams JH, et al. Characteristics of fetal anticonvulsant syndrome associated autistic disorder. Dev Med Child Neurol. 2005;47(8):551–555.
   PubMed Web of Science ®Google Scholar
• Bromley RL, Mawer GE, Briggs M, et al. The prevalence of neurodevelopmental disorders in children prenatally exposed to antiepileptic drugs. J Neurol Neurosurg. 2013;84(6):637–643.
   PubMed Web of Science ®Google Scholar
• Dean JC, Hailey H, Moore SJ, et al. Long term health and neurodevelopment in children exposed to antiepileptic drugs before birth. J Med Genet. 2002;39(4):251–259.
   PubMed Web of Science ®Google Scholar
• Veiby G, Daltveit AK, Schjølberg S, et al. Exposure to antiepileptic drugs in utero and child development: a prospective population‐ based study. Epilepsia. 2013;54(8):1462–1472.
   PubMed Web of Science ®Google Scholar
• Daugaard CA, Pedersen L, Sun Y, et al., Association of prenatal exposure to valproate and other antiepileptic drugs with intellectual disability and delayed childhood milestones. JAMA Network Open. 3(11): e2025570. 2020.
   PubMed Web of Science ®Google Scholar
• Coste J, Blotiere P, Miranda S, et al. Risk of early neurodevelopmental disorders associated with in utero exposure to valproate and other antiepileptic drugs: a nationwide cohort study in France. Sci Rep. 2020;10(1):17362.
   PubMed Web of Science ®Google Scholar
• Blotière P, Miranda S, Weill A, et al. Risk of early neurodevelopmental outcomes associated with prenatal exposure to the antiepileptic drugs most commonly used during pregnancy: a French nationwide population-based cohort study. BMJ Open. 2020;10(6):e034829.
   PubMed Web of Science ®Google Scholar
• Knight R, Wittkowski A, Bromley RL. Neurodevelopmental outcomes in children exposed to newer antiseizure medications: a systematic review. Epilepsia. 2021:1–15.
   PubMed Web of Science ®Google Scholar
• Bromley RL, Mawer G, Love J, et al. Early cognitive development in children born to women with epilepsy: a prospective report. Epilepsia. 2010;51(10):2058–2065.
   PubMed Web of Science ®Google Scholar
• Deshmukh U, Adams J, Macklin EA, et al. Behavioral outcomes in children exposed prenatally to lamotrigine, valproate, or carbamazepine. Neurotoxicol Teratol. 2016;54:5–14.
   PubMed Web of Science ®Google Scholar
• Brodie MJ, Yuen AW. Lamotrigine substitution study: evidence for synergism with sodium valproate? 105 study group. Epilepsy Res. 1997;26(3):423–432.
   PubMed Web of Science ®Google Scholar
• Pisani F, Oteri G, Russo MF, et al. The efficacy of valproate-lamotrigine comedication in refractory complex partial seizures: evidence for a pharmacodynamic interaction. Epilepsia. 1999;40(8):1141–1146.
   PubMed Web of Science ®Google Scholar
• Tomson T, Battino D, Bonizzoni E, et al., Dose-dependent teratogenicity of valproate in mono- and polytherapy: an observational study. Neurology. 85(10): 866–872. 2015. .
   PubMed Web of Science ®Google Scholar
• Ujházy E, Mach M, Navarová J, et al. Teratology – past, present and future. Interdiscip Toxicol. 2012;5(4):163–168.
   PubMedGoogle Scholar
• Vajda FJE, O’Brien TJ, Lander CM, et al. Teratogenesis in repeated pregnancies in antiepileptic drug-treated women. Epilepsia. 2013;54(1):181–186.
   PubMed Web of Science ®Google Scholar
• Azzato EM, Chen RA, Wacholder S, et al. Maternal EPHX1 polymorphisms and risk of phenytoin-induced congenital malformations. Pharmacogenet Genomics. 2010;20(1):58–63.
   PubMed Web of Science ®Google Scholar
• Jose M, Banerjee M, Mathew A, et al. Pharmacogenetic evaluation of ABCB1, Cyp2C9, Cyp2C19 and methylene tetrahydrofolate reductase polymorphisms in teratogenicity of anti-epileptic drugs in women with epilepsy. Ann Indian Acad Neurol. 2014;17(3):259–266.
   PubMed Web of Science ®Google Scholar
• Perucca P, Anderson A, Jazayeri D, et al. Antiepileptic drug teratogenicity and De Novo genetic variation load. Ann Neurol. 2020;87(6):897–906.
   PubMed Web of Science ®Google Scholar
• Johnson EL, Burke AE, Wang A, et al. Unintended pregnancy, prenatal care, newborn outcomes, and breastfeeding in women with epilepsy. Neurology. 2018;91(11):e1031–e1039.
   PubMed Web of Science ®Google Scholar
• King A, Gerard AE. Contraception, fecundity, and pregnancy in women with epilepsy: an update on recent literature. Curr Opin Neurol. 2022;35(2):161–168.
   PubMed Web of Science ®Google Scholar
• Meador K, Pennell PB, May RC, et al. Effects of periconceptional folate on cognition in children of women with epilepsy NEAD study. Neurology. 2020;94(7):e729–e740.
   PubMed Web of Science ®Google Scholar
• Tomson T, Battino D, Bromley R, et al. Global survey of guidelines for the management of epilepsy in pregnancy: a report from the international league against epilepsy task force on women and pregnancy. Epilepsia Open. 2020;5(3):366–370.
   PubMedGoogle Scholar
• Tomson T, Battino D, Bromley R, et al. Management of epilepsy in pregnancy: a report from the international league against epilepsy task force on women and pregnancy. Epileptic Disord. 2019;21(6):497–517.
   PubMed Web of Science ®Google Scholar
• NICE. Epilepsies: diagnosis and management. 2012
   Google Scholar
• Arfman I, Wammes-van der Heijden EDA, Wammes-van der Heijden EA, et al. Therapeutic drug monitoring of antiepileptic drugs in women with epilepsy before, during, and after pregnancy. Clin Pharmacokinet. 2020;59(4):427–445.
   PubMed Web of Science ®Google Scholar
• Birnbaum AK, Meador KJ, Karanam A, et al. Antiepileptic drug exposure in infants of breastfeeding mothers with epilepsy. JAMA Neurol. 2020;77(4):441–450.
   PubMed Web of Science ®Google Scholar
• Herzog AG, Mandle HB, Cahill KE, et al. Predictors of unintended pregnancy in women with epilepsy. Neurology. 2017;88(8):728–733.
   PubMed Web of Science ®Google Scholar
• Schmidt D, Lçscher W. Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience. Acta Neurol Scand. 2005;111(5):291–300.
   PubMed Web of Science ®Google Scholar
• Healy L, Moranb M, Singhalc S, et al. Relapse after treatment withdrawal of antiepileptic drugs for Juvenile absence epilepsy and Juvenile myoclonic epilepsy. Seizure. 2018;59:116–122.
   PubMed Web of Science ®Google Scholar
• Global health 5050. Global Health 5050 Report (2018). Available at; globalhealth5050.org/report/ (accessed Dec 28, 2018)
   Google Scholar
• UN General Assembly. Convention on the elimination of all forms of discrimination against women. Geneva: United Nations General Assembly. 1979. p. 40. 39.
   Google Scholar
• UN. Gender equality. Available at: www.un.org/en/sections/issues-depth/gender-equality/index.html (accessed Nov 10, 2018)
   Google Scholar
• Gilman C. The man-made world: or, our androcentric culture. New York: Johnson; 1971.
   Google Scholar
• Hilhorst D, Porter H, Gordon R Challenging humanitarianism beyond gender as women and women as victims #PressforProgress. Africa at LSE Blog. March, 2018. Available at: //blogs.lse.ac.uk/Africaatlse/2018/03/07/challenging-humanitarianism-beyondgender-as-women-and-women-as-victims-pressforprogress/ (accessed Nov 16, 2018)
   Google Scholar
• Beneria L, Berik G, Floro M. Gender, development and globalization: economics as if all people mattered. New York: Routledge; 2003.
   Google Scholar
• Toledo M, Mostacci B, Bosak M, et al. Expert opinion: use of valproate in girls and women of childbearing potential with epilepsy: recommendations and alternatives based on a review of the literature and clinical experience-a European perspective. J Neurol. 2021;268(8):2735–2748.
   PubMed Web of Science ®Google Scholar
• Shannon G, Jansen M, Williams K, et al., Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet. 393(10171): 560–569. 2019. .
   PubMed Web of Science ®Google Scholar
• Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282(6):583–589.
   PubMed Web of Science ®Google Scholar
• Greenwood N, Carnahan S, Huang L. Patient–physician gender concordance and increased mortality among female heart attack patients. Proc Natl Acad Sci USA. 2018;115(34):8569–8574.
   PubMed Web of Science ®Google Scholar
• Wallis CJ, Ravi B, Coburn N, et al. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017;359:j4366.
   PubMedGoogle Scholar
• Tsugawa Y, Jena AB, Figueroa JF, et al. Comparison of hospital mortality and readmission rates for medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206–213.
   PubMed Web of Science ®Google Scholar
• Dahrouge S, Seale E, Hogg W, et al. A comprehensive assessment of family physician gender and quality of care: a cross sectional analysis in Ontario. Med Care. 2016;54(3):277–286.
   PubMed Web of Science ®Google Scholar