What are the AAN/AES treatment guidelines for epilepsy during pregnancy?

Updated: May 30, 2019
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

In 2009, the American Academy of Neurology and the American Epilepsy Society issued new guidelines for the management of antiepileptic drugs (AEDs) during pregnancy. [57, 59, 60] These guidelines cover obstetric complications and change in seizure frequency; teratogenesis and perinatal outcomes; and vitamin K, folic acid, blood levels, and breastfeeding.

Woman of childbearing age should take folic acid, at least 0.4 mg per day, to decrease the rate of neural-tube malformations in the fetus. In addition, evidence strongly suggests that, during pregnancy, women should take the medication that best controls their epilepsy. Switching medications during pregnancy is not recommended, because of the risk of losing seizure control and because it exposes the fetus to polypharmacy. Data from multiple studies show an exponential risk of birth defects as anticonvulsants are added in polytherapy.


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