The management of pregnant women with epilepsy: a multidisciplinary collaborative approach to care

Abstract

Key content Epilepsy is the most common serious neurological problem encountered in pregnancy; however, women with epilepsy are often not referred to high‐risk pregnancy services. The 2015 Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE‐UK) report on maternal mortality highlights that the care of pregnant women with epilepsy requires urgent improvement. The two most recently available guidelines (Scottish Intercollegiate Guidelines Network and Royal College of Obstetricians and Gynaecologists guidelines) require comparative critical appraisal. Collaboration between general practitioners, specialist epilepsy nurses/midwives, obstetricians, obstetric physicians, neurologists and anaesthetists is vital to ensure optimal standardised management. Learning objectives To understand the role of pre‐conception counselling: to include advice on seizure control, anti‐epileptic drugs (AEDs) and pre‐conception folic acid. To understand the risk factors associated with poor outcomes in pregnant women with epilepsy. To understand the risks associated with specific types of AEDs: mono‐ and polytherapy. To understand the issues regarding the titration of AEDs during pregnancy, postnatal and breastfeeding periods. To understand the importance of a multidisciplinary antenatal, intrapartum and postnatal schedule of care and special considerations. Ethical issues When should we advise women to avoid pregnancy? When, how and by whom should AEDs be modified? Are women with epilepsy aware of the risk of sudden unexpected death in epilepsy in pregnancy?

Update to the Hong Kong Epilepsy Guideline: evidence-based recommendations for clinical management of women with epilepsy throughout the reproductive cycle

“…The multidisciplinary team should involve specialists, such as obstetricians and neurologists, who have experience providing care for pregnant women with epilepsy. 56 Monitoring of AED levels during pregnancy may help to guide dosage adjustment. For example, both total and free clearance of lamotrigine may increase substantially during pregnancy, with a peak in the third trimester.…”

Fetomaternal outcomes in pregnancy complicated by epilepsy: a retrospective study

“…It is the most common neurological condition in pregnancy which needs medical treatment. 1 Since 40% of women are in the reproductive age it is fairly common to see epileptic patients embarking on pregnancy. Although most of the pregnancies progress without complications it is considered as a high-risk pregnancy.…”