Women with epilepsy in sub–Saharan Africa: A review of the reproductive health challenges and perspectives for management

Abstract

Background: Epilepsy is one of the commonest neurological conditions affecting women of reproductive age. Epilepsy management during pregnancy is a clinical conundrum, requiring a balance between seizure control and risk minimization for the women with epilepsy (WWE) as well as for their fetuses. The objective of this comprehensive review is to explore the reproductive health challenges of WWE in sub-Saharan Africa (SSA) and ways to address them. Method: Relevant documentation published until June 2019 were retrieved via literature searches performed in PubMed and Google Scholar, as well as a manual search to identify grey literature. Results: WWE in SSA are generally more stigmatized and sexually exploited than women without epilepsy. Contraception use among WWE was reported only in Senegal (51%) and Kenya (14.7%). Only two prospective studies (one in Senegal and one in Nigeria) investigated pregnancy outcomes for a total of 97 WWE. The prevalence of convulsive epilepsy in pregnancy was estimated at 3.33 per 1000. Among pregnant WWE treated with first line anti-epileptic drugs, 16.2% had miscarriages, 41.9% premature births, and 4.1% had babies with malformations. Carbamazepine, which is frequently prescribed to pregnant WWE in SSA, still entails a 2.1-fold increased risk of congenital malformation. No reports were found concerning pre-conceptual counseling and post-natal outcomes in WWE in SSA. Conclusion: Our review underscores the need for contextualized evidence-based clinical guidelines and a collaborative approach to treat WWE in SSA. High risks of congenital malformations and drug interactions with first line AED warrant the provision of safer second line alternatives.

Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

“…Phenobarbital, as all first line AED available in sub-Saharan Africa, has been associated with congenital abnormalities [30]. Therefore, more advocacy is needed to make safer second line AED [31,32] available at an affordable price.…”

The Impact of Antiepileptic Treatment in Pregnancy on Perinatal Outcome in Croatia – a Single-Center Study

“…Approximately 43% of our cohort used VPA in their polytherapy regimen, but with no increase in the risk of major fetal malformations. Current guidelines strongly discourage such approach [19][20][21] . Our findings suggest the higher rate of major fetal malformations in VPA monotherapy group to be dose-related, with no evidence for preconception folate supplementation to reduce that risk.…”

“…Exposure to AED during pregnancy is associated with an increased risk of preterm birth ( 20 ). Furthermore, our study recorded such association and found a significantly increased risk of preterm birth in polytherapy group compared to monotherapy group (p=0.03).…”

Epilepsy management in pregnant HIV+ women in sub-Saharan Africa, clinical aspects to consider: a scoping review

“…In addition, given the geographic overlap with other endemic diseases, a non-negligible proportion of pregnant HIV+ WWE may concomitantly receive treatment with other potentially teratogenic drugs, including anti-TB drugs [32]. Therefore, epilepsy management during pregnancy, particularly in HIV+ women, requires an equilibrium between seizure control, viral load control, co-infection prevention, and risk minimization for the WWE and their fetuses [33].…”