A new guideline has been issued to assist neurologists and clinicians in selecting the best anti-seizure medications for people with epilepsy who may become pregnant. Published in Neurology, the guideline is a collaboration between the American Academy of Neurology (AAN), the American Epilepsy Society (AES) and the Society for Maternal-Fetal Medicine (SMFM), with endorsement from the Child Neurology Society. It updates parts of the 2009 AAN and AES guidelines regarding birth malformations and child development in children born to people with epilepsy.
There is a small risk of pregnancy-related issues due to seizures and anti-seizure medications and the guideline provides recommendations on the effects of these medications and folic acid supplementation on birth malformations and child development during pregnancy. The recommendations are based on a comprehensive review of existing evidence.
Key points from the new guideline include:
- Optimizing seizure control and foetal development with appropriate medications and doses at the earliest opportunity before pregnancy.
- Minimizing tonic-clonic seizures during pregnancy to reduce risks to parent and foetus, as seizure frequency may increase if medications are stopped during pregnancy.
- Preferably using lamotrigine, levetiracetam or oxcarbazepine medications to minimize major birth defects.
- Avoiding valproic acid, phenobarbital and topiramate when possible for people with epilepsy who may become pregnant, to reduce the risk of neurodevelopmental outcomes such as autism spectrum disorder and lower IQ.
- Daily intake of at least 0.4 mg of folic acid before and during pregnancy to decrease the risk of neural tube defects and potentially improve neurodevelopmental outcomes.
Author of the guidelines, Alison M Pack, MD, MPH, of Columbia University in New York City, a Fellow of the American Academy of Neurology and a member of the American Epilepsy Society noted: “People with epilepsy who may become pregnant want to ensure the best health of their child while still managing and minimizing their seizures. This is why it is important to discuss plans for pregnancy with your doctor before becoming pregnant and notify your doctor as soon as possible if you discover you are pregnant. Don’t stop or change your medications. Talk with your doctor about any concerns you have about your medications.”
Disclosure: This article was created by the touchNEUROLOGY team utilizing AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No funding was received in the publication of this article.
Looking for more content on epilepsy? Read the recent articles published in touchREVIEWS in Neurology:
Exploring Cellular Mechanisms and Restorative Cell-based Therapeutics for Epilepsy by Vivek Buch and colleagues
Acute Management of Seizure Clusters and Prolonged Seizures: A Review of Rescue Therapies by Ruben I Kuzniecky and colleagues
