Epilepsy is the most common neurological disease of females in reproductive age. Problems concerning contraception, reproduction, teratogenicity and antiepileptic therapy preceding and during pregnancy are discussed and recommendations made. We underline the advantages of a planned pregnancy with optimal adjustment of antiepileptic drug therapy and recommend prophylactic treatment with folic acid before and during, and with vitamin K towards the end of pregnancy.
PIP: Epilepsy is the most common neurological disease of women of reproductive age. Until the mid 20-th century, its diagnosis meant no possibility of marriage and children. The advances of therapy, however, have assured that most patients can live a normal life. The major points are underscored including the interaction between epilepsy and pregnancy involving the mechanisms of congenital anomalies. The frequency of attacks during pregnancy. Pregnancy complications under epilepsy. Epilepsy and fetal malformations. Pharmacological mechanisms of teratogenicity: epoxides, free radicals, folic acid deficiency, teratogenicity of new antiepileptics and preparation with indications. Pharmacotherapy before and during pregnancy, including contraception in attack-prone patients: oral contraceptives and hormonal abortion (RU-486). Special pharmacokinetics of antiepileptics during pregnancy; dose selection and adjustment, bleeding risk and vitamin K substitution. The planning of pregnancy in epilepsy and prenatal diagnosis. Regarding indications based on existing data, it can be stated that there is a genetically higher risk of congenital malformations with primary epilepsy of parents. The risk of defect depends on the dose and quantity of medications given irrespective of the type of antiepileptics. In stabilized epilepsy, the probability of giving birth to a normal child is over 90%. The risk of congenital defects in the offspring of seizure-prone parents on genetic, and, in the case of antiepileptic therapy on medicament-toxicological grounds, is on the average 2-3 times higher. There is an elevated danger posed for the fetus by the tonic-clonic seizures of the mother through asphyxia and direct injuries by falling. The risk from an uncontrolled epilepsy is higher than the risk of malformation through antiepileptics. It is possible but statistically not proven that valproate results in an increased rate of spina bifida (1% selective risk). Prenatal diagnosis allows detection of early defects to decide on abortion or preterm birth to reduce the neurological deficit.