Anticonvulsant Drugs: Strategies and Choices

Despite uncertainty about the effects of the various anticonvulsants during pregnancy, stopping the medication is seldom an option. Women continue to need medication to prevent severe pain as well as bipolar and associated mood disorders, whether pregnant or not. Most women with epilepsy continue to need medication to prevent seizures during pregnancy as much if not more than at other times. Having even a single convulsive seizure during pregnancy is physically risky for mother and baby. Research shows that frequent (more than five) convulsive seizures during pregnancy negatively affect the child’s future IQ.

Convulsions cause falls, affect oxygen supply to the developing child, and produce massive muscle contractions that may put the pregnancy and even the life of the mother at risk. The risk of maternal death during pregnancy is ten times higher for women with epilepsy than for women in the general population, most commonly associated with seizures as a result of stopping or reducing their anticonvulsants. Even seizures that do not involve convulsions pose additional risk to the baby. For all these reasons, experts recommend that if a change in medication is made, it should take place before conception occurs. This is particularly important because major malformations occur early in development, in the first trimester of pregnancy, often before the woman is even aware that conception has taken place.

So what can be done? How can women and their physicians safely navigate their way through so many unwelcome possibilities? In the past, many women taking anticonvulsants have been advised to avoid pregnancy altogether, advice that today’s experts strongly reject. Current strategies to increase the odds of a successful pregnancy and a healthy baby include keeping anticonvulsant dosages as low as possible during pregnancy, avoiding use of more than one anticonvulsant at a time, and recommending that women take vitamin supplements containing folic acid prior to and during pregnancy.

Of paramount importance in choosing a medication for women with epilepsy continues to be its effectiveness in controlling seizures, during pregnancy as well as at all other times. Similar issues of benefit and risk are equally relevant to women with other medical conditions for whom anticonvulsants are prescribed. Control of the primary medical condition is still primary, but new information about relative risks associated with some of these drugs is adding a new component to the therapeutic equation. In response to that new information, the Epilepsy Foundation has committed itself to identify research trends and share those findings with women and their healthcare providers.