Pregnancy and Epilepsy

Abstract

Women with epilepsy account for approximately 0.5% of all pregnancies. Their pregnancies are high risk because of an increased frequency of maternal seizures, complications of pregnancy, and adverse pregnancy outcomes. The increase in seizure frequency is associated with a progressive decline in antiepileptic drug (AED) levels during pregnancy even with constant dosing. Fetal deaths after a generalized seizure, although rare, have been reported, and a marked decline in fetal heart rate has been demonstrated after such seizures during delivery. AEDs have been implicated in causing a twofold increase in the rate of congenital malformations, a variety of minor physical anomalies, mostly involving the midface, and a neonatal hemorrhagic disorder. The clinician caring for a pregnant woman with epilepsy is therefore faced with a dilemma and must carefully chart a middle ground providing effective seizure control while minimizing fetal exposure to AEDs.

Teratogenic effects of lamotrigine on rat fetal brain: a morphometric study

“…According to the World Health Organization, epilepsy has a prevalence of around 5% of the total population 1 . Therapeutic and surgical practices allow 80% of the patients to have a normal life, with little interference of epileptic seizures in it 2 . Although in the past, reproduction was discouraged in epileptic women, over 90% of pregnancies in such patients currently have an uneventful outcome when appropriately managed 3 .…”

Epilepsy: Quality of Life and Cost of Care

“…Although the prevalence is highest in people under the age of 20, between 680,000 and 1.1 million women of childbearing age in the United States have epilepsy (7,8). Furthermore, the incidence increases over the age of 70 years to more than 100 cases per 100,000 (9), which is attributable, in part, to risk factors for epilepsy that are associated with aging such as Alzheimer's disease, cerebrovascular disease, and brain tumors (10).…”

Transferência placentária de drogas

“…Assim, se as crises epilépticas são bem controladas antes, há pequeno risco de aumento de freqüência durante a gravidez. Por outro lado, se a mulher é mal controlada antes da gravidez, há maior probabilidade de as crises se agravarem 30 . Em trabalho retrospectivo avaliando 126 pacientes com epilepsia, 69% destas apresentaram evolução favorável da epilepsia, sem alteração signifi cativa da freqüência das crises, o que torna factível a suspensão de drogas em pacientes bem controladas, pois as mesmas representaram 80% da pacientes com evolução favorável 31 .…”