1. What should I do if I want to get pregnant with epilepsy?
Before becoming pregnant, a preconception consultation with an epilepsy specialist and an obstetrician should be conducted to understand the pregnancy complications associated with epilepsy and the possible teratogenic effects of antiepileptic drugs in order to decide the risks of pregnancy. Prior to pregnancy, one should ensure that one has been seizure-free for at least the last 6 months. The physician should then perform a comprehensive assessment of the condition and select the smallest dose of antiepileptic to control seizures, depending on the type of seizure, and try to treat with monotherapy. If a change in medication is required, it should be ensured that effective blood levels are achieved before pregnancy.
Four points in particular should be noted: (1) medication adjustments should preferably be completed before conception; (2) try to start pregnancy preparation after seizure control is stable; (3) avoid valproic acid, paroxetone, and phenobarbital if possible; and (4) try to adjust AEDs to the lowest effective dose of monotherapy.
If one is really prepared, oral administration of 5 mg/d high-dose folic acid during the first 1 month of pregnancy and 2 months after conception is recommended to reduce the risk of congenital malformations in the fetus to some extent.
2. Do antiepileptic drugs have an effect on women’s menstruation?
Epilepsy itself and antiepileptic drugs can have an effect on menstruation in women during their reproductive years. Seizures can lead to endocrine disorders, resulting in an increased risk of reproductive endocrine disorders such as polycystic ovary syndrome, hyperandrogenemia, hyperprolactinemia, infertility and menopause. Anti-epileptic drugs may affect the level of sex hormone metabolism, which may also lead to reproductive endocrine abnormalities.
3. What happens when I keep having epilepsy during my menstrual period? What should I pay attention to when taking medication?
Some fertile women have frequent seizures around the time of menstruation or during menstruation, known as menstrual epilepsy. This may be due to cyclical changes in estrogen and progesterone levels in women during menstruation, as well as changes in the concentration of antiepileptic drugs.
In case of menstrual epilepsy, it is recommended not to take such drugs as valproic acid, which may increase the risk of hyperandrogenemia and polycystic ovary syndrome and even affect fertility in fertile female patients.
Drugs with hepatic microsomal enzyme-inducing effects such as carbamazepine, oxcarbazepine, phenytoin sodium, phenobarbital, and topiramate may lead to increased metabolism of steroid hormones including estrogen and progesterone, but there is no evidence that these drugs induce menstrual epilepsy.
4. Should women with epilepsy take antiepileptic drugs if they are pregnant
The vast majority of women with epilepsy need to continue taking AEDs during pregnancy to avoid adverse effects on the pregnancy and fetus due to seizures.
5. What are the adverse effects of taking antiepileptic drugs in pregnancy on the fetus?
It may increase the potential risk of miscarriage, congenital malformation of the fetus, intrauterine growth restriction, delivery bleeding and other adverse events.
6.What else should I pay attention to when I am pregnant, besides taking medication?
When you are pregnant, in addition to routine prenatal checkups, you should see an epileptologist regularly to find out what adverse effects seizures can have on the mother and fetus during pregnancy. The doctor, in turn, should dynamically assess the patient’s seizure risk based on clinical presentation and tests such as EEG, so that the dose and type of medication can be adjusted in a timely manner. If seizures increase after pregnancy, it is important to consider whether they are related to pregnancy vomiting, or failure to take medication on time and in the right dosage. Tonic-clonic seizures can lead to fetal bradycardia, hypoxia and even miscarriage.
7. Can antiepileptic drugs affect the fetus?
All current antiepileptic drugs can cross the placenta and reach the fetus. Some drugs such as phenobarbital and paroxetine can accumulate in the fetus and increase the risk of fetal malformation. The probability of teratogenicity of one drug during pregnancy is about 3% (about 2% in normal population), while the rate of teratogenicity of multi-drug combination therapy can be as high as 17%. Therefore, multiple drugs should be avoided as much as possible during pregnancy. In the early stages of pregnancy, drugs have the greatest impact on the fetus. Ultrasound examination should be performed on the fetus at 18-20 weeks of gestation to detect possible congenital malformations of the heart, craniofacial bones and neural tube in time.
Newer drugs such as lamotrigine, levetiracetam, topiramate, oxcarbazepine, zonisamide, and gabapentin may improve the tolerability of drugs in pregnancy and be less teratogenic to the fetus than older drugs such as valproic acid and caspiride, but the research evidence is less adequate. However, it is certain that topiramate can cause limb skeletal abnormalities, congenital heart disease, cleft lip and other malformations, so it is recommended not to take it. Do not take sodium valproate either, because it has a greater teratogenic effect.
8.What should I pay attention to when taking medication before delivery?
During labor and delivery, patients with epilepsy are three times more likely than normal women to have complications such as toxemia, severe eclampsia, placental hemorrhage and preterm delivery, and the perinatal mortality rate can increase two times. Patients are advised to have their blood levels monitored every two months before delivery, and drug doses should be adjusted promptly if control is poor. Throughout the perinatal period, patients should take their medications regularly, while taking care to avoid the influence of sleep and emotions. Carbamazepine, oxcarbazepine, phenobarbital, phenytoin sodium, and topiramate can cross the placenta to promote vitamin K1 degradation in the fetus, leading to an increased risk of neonatal hemorrhagic disease. Patients are advised to take 20 mg of vitamin K1 orally daily in the last month of pregnancy to reduce the risk of hemorrhagic disorders in the fetus.
9. Which is better, giving birth on your own or by cesarean section, and what about seizures during labor?
The vast majority of women with epilepsy can have a normal vaginal delivery. About 2%-4% of patients will have tonic-clonic seizures during or within 24 h after delivery, resulting in maternal and fetal hypoxia. 10-20 mg of Valium should be given immediately by slow intravenous injection to terminate the seizure, and if necessary, the seizure should be treated as persistent status epilepticus. If the seizure is such, stabilize the condition to deliver by cesarean section as soon as possible. Immediately after birth, the newborn should be given 1mg of vitamin K1 intramuscularly. To reduce the risk of hemorrhagic disease in the newborn.
10. Can I breastfeed after delivery while taking antiepileptic drugs?
Patients with epilepsy should continue to take antiepileptic drugs after delivery. The dose of medication may be increased in some patients during pregnancy and will be adjusted on an individual basis after reassessment by an epilepsy specialist. A gradual reduction in dose to pre-pregnancy levels is usually recommended over the weeks following delivery. Most patients can be breastfed under medical supervision. Breastfeeding should be discontinued immediately if prolonged sedation, lack of interest in feeding, or lack of increase in body mass occurs during breastfeeding. For example, phenobarbital may cause decreased arousal and lethargy in newborns, valproic acid may be associated with irritability in newborns, and lamotrigine may induce rash in newborns.