Pregnant women with epilepsy face dilemma - continue treatment and risk birth defects

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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."

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