Epilepsy in pregnancy

Question 1

what contraceptive methods are best used in people with epilepsy and why?

Answer 1

if they are on enzyme inducing anti-epileptic medications, then oral contraceptives won’t work

• Copper IUD
• LNG IUD
• depot provera (medroxyprogesterone acetate injections)

Question 2

what emergency contraception method is best used in people who are on AED’s and why?

Answer 2

Copper IUD

if they are on enzyme inducing AED’s i.e. carbamazepine, then oral levonorgestrel and ullipristal will have a reduced affect

Question 3

what are the teratogenic risks of sodium valproate and is it safe to take in pregnancy and when breast feeding?

Answer 3

considered safe when breast feeding

risk of neural tube defects and long term neurodevelopment delay

shouldn’t be taken during pregnancy and in any women within reproductive age

Question 4

what is the teratogenic risk of the use of phenytoin?

Answer 4

cleft palate

Question 5

what prophylaxis can be taken in pregnant woman who are on AED’s and why?

Answer 5

all patients should take 5mg folic acid months before conception and up to at least end of 1st trimester

patients on phenytoin should take 1g i/m vitamin K in 3rd trimester to prevent clotting disorder in neonate

Question 6

is it safe to breast feed when on AED’s ?

Answer 6

yes it is safe with the exception of barbiturates

Question 7

does epilepsy become worse during pregnancy?

Answer 7

2/3rds of patients with epilepsy don’t have an increase in seizures during pregnancy

Question 8

excluding risk of teratogenicity, what complication during pregnancy is associated with some AED’s?

Answer 8

risk of preterm labour associated with carbamazepine and lamotrigine