Which organizations have issued treatment guidelines for pregnant women with epilepsy?

Updated: Aug 20, 2019
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Most women of childbearing potential who have epilepsy expect to become pregnant. Epilepsy is not in itself a contraindication to pregnancy; however, seizure management should be optimized before pregnancy is considered. If seizures are not acceptably controlled, attention to compliance is recommended. Furthermore, video or electroencephalographic (EEG) monitoring is recommended for classifying intractable seizures before conception so as to optimize treatment and minimize the risk to the woman and the fetus.

Patients with mixed (ie, epileptic and nonepileptic) seizure types who are noncompliant with pharmacotherapy pose a particularly challenging management situation.

A fair amount of information is available on how to optimize seizure management while minimizing maternal and fetal risk. Preconception discussions between the woman and her health care provider and consultation with a neurologist provide the best opportunities for applying this information to a particular pregnancy. (See Seizure Disorders in Pregnancy.)

Three practice parameters published in 2009 by the American Academy of Neurology (AAN) and the American Epilepsy Society (AES) provide valuable information for women with epilepsy who are pregnant or planning to become pregnant. [18, 19, 20] (See AAN Practice Guidelines & Tools.) The AAN/AES guidelines affirm that in general, it is safe for women with epilepsy to become pregnant, but they make specific suggestions with regard to managing the medications these women are taking before and during pregnancy (see below).


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