Pregnant women with epilepsy face dilemma
Continue treatment and risk birth defects?
An article in the journal Epilepsia reviewed recent data on the risks associated with continuation of medical treatment of women with epilepsy during their pregnancies. While the general consensus is that use of antiepileptic drugs is associated with increased risk for birth defects, physicians weigh this risk against that of uncontrolled epileptic seizures, which can be more harmful to the fetus than the actual drugs.
Most women with active epilepsy choose to continue with drug therapy during pregnancy and have more than 90% chance to give birth to a perfectly healthy child. It remains unsolved whether risks for birth defects vary with different drugs.
One drug, valproate, has been associated with a higher risk of birth defects than some others although the reasons for this have not been completely clarified. However, for some patients, valproate is the most effective medication for controlling the seizures, which must be balanced against the risk.
An additional concern could be possible postnatal effects of anti-epileptic drugs to the child which do not become apparent until school age.
The Commission on Genetics, Pregnancy, and the Child of the International League Against Epilepsy (ILAE) developed guidelines in 1989 for the care of women with epilepsy of childbearing age, including the optimization of treatment before conception and using lowest effective dosages for seizure type and syndromes. However, the guidelines offered limited help for physicians in how to council patients considering epilepsy treatment during their pregnancy. With this new review, doctors have more data and advice until more conclusive data is reached.
"The risk of inducing harmful seizures by abrupt withdrawal of treatment is stressed and the importance of individual counseling is underlined," states author, Dr. Torbjörn Tomson. "The importance of maintained seizure control for the well-being of women with epilepsy, as well as for their unborn children, must be kept in mind."
About the Author
Torbjörn Tomson, MD is Head of the Section of Epileptology in the Department of Neurology, Karolinska Hospital since 1994. He received his degree at the Karolinska Institute and is currently Chairman of the Commission on Therapeutic Strategies, International League Against Epilepsy (ILAE). Dr. Tomson can be reached for questions and interviews at [email protected]
Media wishing to receive a PDF of this article please contact [email protected].
Epilepsia is the leading, most authoritative source for current clinical and research results on all aspects of epilepsy. As the journal of the International League Against Epilepsy, Epilepsia presents subscribers with scientific evidence and clinical methodology in: clinical neurology, neurophysiology, molecular biology, neuroimaging, neurochemistry, neurosurgery, pharmacology, neuroepidemiology, and therapeutic trials. Each monthly issue features original peer reviewed articles, progress in epilepsy research, brief communications, editorial commentaries, special supplements, meeting reports, book reviews, and announcements.
About the International League Against Epilepsy
The International League Against Epilepsy (ILAE) was founded in Budapest in September 1909. It has branches now in 92 countries and over 15,000 members. It is a non-profit and non-governmental association, with official links with the World Health Organization and the International Bureau for Epilepsy. It is the world's preeminent association of physicians and other health professionals working towards a world where no persons' life is limited by Epilepsy. Its mission is to provide the highest quality of care and well-being for those afflicted with the condition and other related seizure disorders. For information on epilepsy and education, please visit www.ilae.org for a patient brochure under the "resources" link.
About Blackwell Publishing
Blackwell Publishing is the world's leading society publisher, partnering with more than 600 academic and professional societies. Blackwell publishes over 750 journals and 600 text and reference books annually, across a wide range of academic, medical, and professional subjects.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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