Management of Epilepsy for Women of Childbearing Age

Abstract

In the management of epilepsy in women of childbearing age, preparations for potential pregnancy should begin from adolescence.

Regarding antiseizure medications and contraception, some antiseizure medications, including enzyme-inducing drugs, may reduce the effectiveness of oral contraceptives when used in combination. Combining lamotrigine with oral contraceptives can lower lamotrigine blood levels, increasing the risk of seizure frequency.

Supplementing women with epilepsy with folic acid before they become pregnant should be considered.

The teratogenicity of antiseizure medications generally shows dose-dependency, so treatment should aim for the minimum necessary dosage. In general, valproate is considered to have a high teratogenic risk, and fetal exposure to valproate can affect cognitive function after birth. For some antiseizure medications, the maternal physiological changes during pregnancy can lead to decreased blood levels, requiring dosage adjustments.

Breastfeeding by mothers with epilepsy who are taking antiseizure medications is generally possible. Most reports indicate that antiseizure medications transferred through breast milk do not negatively impact the cognitive function of infants.