Treating epilepsy in pregnant women

Introduction: The management of epilepsy during pregnancy involves achieving the best compromise between the sometimes competing aims of maintaining the well-being of the prospective mother and that of her foetus. Recently available knowledge helps achieve this by providing a better understanding of the hazards that intrauterine exposure to antiepileptic drugs holds for the development of the body structure and aspects of the intellect of the human foetus. The newer knowledge also helps explain why maternal seizure control may deteriorate during pregnancy, and how this risk may be avoided. Areas covered: A survey of the relevant English language literature concerning human epilepsy and pregnancy, foetal outcomes from pregnancy in women with epilepsy, and antiepileptic drug pharmacokinetics and clinical efficacy during pregnancy was carried out Expert opinion: A mother's past history of foetal malformations, and the intake of valproate during a pregnancy, are significant factors in increasing the hazard of malformations during that pregnancy. Therefore, as far as reasonably possible, valproate use during pregnancy is better avoided. Full seizure control in the pre-pregnancy year, and adjusting antiepileptic drug doses to maintain plasma drug concentrations throughout pregnancy at values associated with seizure control before pregnancy, have major influences in preserving seizure control during pregnancy.