*Epilepsy in pregnancy

Question 1

Folic acid in preg with epilepsy

Answer 1

Folic acid 5mg pre pregnancy till 12 wks gestation

To avoid spina bifida, neural tube defects caused by epileptic drugs

Normally 0.4mg till 12wks preg

Question 2

Epileptic drugs and teratogenicity

Answer 2

1. CARBAMAZEPINE - safer
   - causes spina bifida
2. Phenytoin
   -Cleft lip, palate
   -Congenital heart disease
3. Sodium valproate - not used
   -spina bifida

4 Lamotrigene - currently used
Levetiracetam

*Anti epileptics - small dose in breast milk but do not stop feeding

*Higher oestrogen OCP as anti epileptics increase liver enzyme activity

Question 3

Mx of epilepsy in preg

Answer 3

Refer to neurologist
1. If well controlled since 2 yrs - medication free T1
reintroduce in T2

2. Very well controlled - rx free pregnancy
3. Not well controlled
   ●If on sod valproate, planning preg
   -Decrease dose, stop
   -Start on lamotrigene and levetiracetam

●On sod valproate, 8wks pregnant
-No benefit of reducing dose/stopping valproate (risk of seizure if you change drug)
-Continue valproate