Last year was said to be a “good year”, so young men and women were eager to get married, and epileptics were no exception. I have been diagnosing and treating epilepsy for more than 10 years, and so far I have had about 20 or so women with epilepsy who became pregnant and had children.
I think the reason for this is not only that last year was a good year, but also that over the years, my patients have changed from young girls to young women.
I have always encouraged my patients to study, work and live as if they were normal people, and I often encourage them to find jobs and get married.
There have been many times when both men and women were ready to get married before the woman told the man about her illness history, after which they came to me together for counseling. I defend my patients’ interests (not favoritism!) I tell them that epilepsy is not scary at all and that it is absolutely fine for them to get married, but that they have to switch to less teratogenic medication before they get pregnant.
There have also been times when the woman has been pregnant (both before and after marriage) before she brought her husband or boyfriend in for a consultation. To avoid scaring him, I concealed the medical history for the woman (not deception!) ), I tell him that she has an episodic disease that requires long-term medication; that the disease is not hereditary, and that the medication she is using now has little effect on the fetus, and that she can continue the pregnancy, but that she must have strict maternity checks afterwards.
In short, I will try to explain clearly to the man that epilepsy is not scary, it is only our perceptions that are scary. I use the example of my twenty patients who all gave birth to healthy children to encourage them to face the disease head on, but of course, the ultimate choice is in their own hands.
Eventually, more people get married and more pregnant women naturally become pregnant. Last year, one of the female patients had an early miscarriage after pregnancy, and the rest of the patients who managed to get pregnant, with and without seizures during pregnancy, produced children with all five senses, limbs and hearts sound. As for the greatest concern of intelligence, we can only wait until the future to know. But I think, who can guarantee that their children will be of superior intelligence? Who can guarantee that a child with superior intelligence will live a happy life in the future? And who can guarantee that a child with a little less intelligence will grow up to do nothing?
When a child is born, the first problem is breastfeeding.
”Can I breastfeed?” is the question of every female patient or family member with epilepsy.
Just last week, a woman in labor came over for a follow-up appointment. The patient had almost a ten-year history of the disease and had been on medication but poorly controlled. She had a pregnancy two years ago, which was later miscarried. She became pregnant again last year, but the seizures increased significantly after that, and despite increasing the medication to the maximum amount, the patient was hospitalized several times because of frequent seizures. After the delivery, the obstetrician requested a consultation, but the consultation doctor thought that she could not breastfeed and forced the obstetrician to give her an injection! When I asked her about breastfeeding at her follow-up appointment one month after discharge, I learned that she was not breastfeeding.
Today, a patient’s mother called me happily to report that her daughter had given birth to a baby. While I was happy for her, I did not forget to tell her to breastfeed as much as possible.
Two weeks ago, the mother of a female patient came all the way over to thank me: her daughter had given birth to a sound boy and the male family was overjoyed. The patient’s mother was even happier, finally the nightmare was over! The patient was pregnant out of wedlock, the man didn’t know anything about the girl’s condition, and the girl had been afraid to tell him; after the pregnancy, the wedding was hastily held and the man and woman only really lived together. The wife had no explanation for her condition, and she could only take her medication secretly behind her husband’s back, leading to too much psychological pressure and frequent seizures at night, which could not be controlled even though the medication was increased to the maximum amount. I thought her seizures were both real and “fake” and suggested that she bring her husband over and I would explain to him, but she didn’t dare to do so, lying to him that she was not sleeping well at night after her pregnancy and that’s why she was moving her arms and legs unconsciously. I’ve been trembling for nine months, and today I finally got it right. Her mother wanted to send me a red envelope to thank me for my care, support, and treatment over the past few months. I politely declined, as I felt it was my duty to do so. Before her mother left, I gave her a piece of advice: breastfeed as much as possible!
Many people with epilepsy and their families are afraid to breastfeed their children because they feel that the breast milk contains drugs and that the child’s breast milk is the same as taking medicine, “The child doesn’t have epilepsy, so why take epilepsy medicine?”
Theoretically, this is good to consider. On the surface, it’s true that you shouldn’t let your child take medicine for no reason. But in fact, this is a misconception: you can’t just consider things from a purely theoretical point of view.
First, when a person with epilepsy becomes pregnant, the fertilized egg begins to be affected by the mother’s medications. Antiepileptic drugs can enter the fetal circulation through the mother’s bloodstream and the blood-placental barrier, which means that the fetus is “taking” antiepileptic drugs throughout the mother’s pregnancy: there is no need to take the drugs by mouth, and they enter the fetus directly through the bloodstream. Some drugs are teratogenic and should not be used during pregnancy, especially not in the early trimester. Some babies are not breastfed after birth, and when they suddenly “stop” the medication, they can become irritable and even have convulsions.
Secondly, after the birth of the fetus, it becomes a baby and cannot take nutrients from the mother’s blood circulation, so it must eat. The feeding can be breast milk, milk of other animals, or milk substitutes. Breast milk has nutritional advantages that other dairy products do not have, as well as the advantages of increasing the bond between mother and child and reducing psychological disorders in the child’s adult life, and is highly respected.
Also, breast milk is an active secretion process. The nutrients in the blood are synthesized into milk in the mammary glands, but not all the ingredients in the blood can pass through the mammary glands and enter the milk. Many drugs are not, or are only, secreted in very small amounts in breast milk, so the concentration of antiepileptic drugs in breast milk may be 10-50% of that in the blood, and the total amount of drugs is very weak. However, even this may be a relatively large amount of medication relative to the weight of the infant, but the infant’s metabolism is vigorous and any medication that enters the body is quickly excreted.
Finally, there is the public topic. It is difficult for parents to keep their infants from consuming breast milk containing epilepsy medications, and it is difficult to ensure that other dairy products the infant eats are free of medications, that the air the infant breathes is free of pollution, that the water the infant drinks is free of heavy metals, and that the vegetables and fruits the infant eats are free of pesticides.
Therefore, overall, the infant benefits more from breastfeeding by the mother with epilepsy. Of course, this needs to be understood based on the mother’s knowledge of the disease, of the medication, of breastfeeding, and of the surrounding environment.
In the end it is the right of the family to choose how to do it.