Therapy Insight: Clinical Management of Pregnant Women With Epilepsy

Alison M. Pack

Disclosures

Nat Clin Pract Neurol. 2006;2(4):190-200. 

In This Article

Seizure Frequency During Pregnancy

Seizure frequency can increase or decrease in an unpredictable manner during pregnancy, and the nature of the change is not related to seizure type, duration, or seizures in previous pregnancies. Changes in seizure frequency are thought to be secondary to multiple factors, including alterations in the concentration and type of circulating steroid hormones during pregnancy, changes in maternal physiology that result in alterations in the pharmacokinetics of prescribed AEDs, and poor compliance with the drug regimen if the mother fears potential teratogenesis from AED use.

In the nonpregnant state, the main circulating estrogens in the body are estradiol and estrone. In pregnancy, the concentrations of both of these estrogens increase, and levels of estriol—a peripheral metabolite of estrone and estradiol—show an even more marked increase. Progesterone production also increases dramatically. These hormonal changes might have direct consequences on the presentation of seizures, as it has been suggested that estrogen has proconvulsant properties, whereas progesterone has antiepileptic effects.[1]

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