Can I get pregnant with epilepsy?
The uncertainty whether one can become pregnant with a known epilepsy affects many women. The question of heredity, side effects of medication and damage to the child in the event of an epileptic seizure during pregnancy are often the most pressing. As a rule, epilepsy does not rule out pregnancy.
Ideally, however, pregnancy should be planned and the particularities during pregnancy should be discussed with the treating neurologist and gynaecologist in order to eliminate the greatest worries on the one hand and reduce the existing risks on the other. This can be done by adjusting the current medication, regular blood checks and preventive and ultrasound examinations. As a rule, pregnancies with a known epilepsy then proceed without complications.
Which epilepsy medications may I take?
Taking antiepileptic drugs increases the risk of malformations by a factor of three compared to children of healthy mothers who do not take medication. Clinical studies have shown that monotherapy, i.e. taking just one drug, significantly reduces the risk compared to combination therapies. These should therefore be avoided if possible.
In addition, the lowest effective daily dose should be determined and the drug should be taken evenly throughout the day to avoid high concentration peaks in the blood. Especially under combination therapies, but sometimes also under monotherapy, a decrease in folic acid concentration can occur. This decrease increases the risk of cranial fissures and neural tube defects.
For this reason, folic acid should be taken daily, especially during the first third of pregnancy. In principle, any anti-epileptic drug can be taken during pregnancy under these conditions. In the first three months, however, the intake of valproic acid should be avoided as far as possible, since this therapy has the highest rate of malformation.
However, since valproic acid is very effective and difficult to avoid, especially in generalized epilepsies, daily doses of more than 1000mg and blood levels of more than 80mg/l should not be exceeded. Enzyme-reducing antiepileptic drugs (e.g. phenytoin, phenobarbital, primidone, carbamazepine) can lead to coagulation disorders and thus an increased bleeding tendency, which in the worst case can cause cerebral haemorrhages in the child and abdominal bleeding in the mother during or shortly after birth. To avoid this, the mother should be given vitamin K shortly before and the baby shortly after birth.
Phenytoin and phenobarbital can lead to vitamin D deficiency. A diet containing vitamin D and sufficient sunlight can prevent this deficiency. In any case, it should be noted that the maternal body may also work differently during pregnancy.
This means that the medication may be better or worse absorbed or broken down, which affects the concentration of the medication in the blood. In order to prevent an over- or underdose of the respective antiepileptic drug, a blood check should therefore be carried out regularly. Lamotrigine is the drug of first choice for focal epilepsies with and without secondary generalization, primarily generalized seizures and seizures resistant to treatment.
It is the drug of choice for depressed patients with seizure disorders. Advantages are that it has no sedative and soporific effect and increases intellectual performance. Overall, Lamotrigine has few side effects and is not harmful to the unborn child and is therefore the drug of choice during pregnancy. The only serious side effect is Steven Johnson syndrome (acute skin rashes).
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