Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-25T06:59:27.087Z Has data issue: false hasContentIssue false

Chapter 12 - Seizure Management in Pregnancy

Published online by Cambridge University Press:  19 December 2024

By
Ginette Moores
Edited by
Esther Bui  and
P. Emanuela Voinescu
Esther Bui
Affiliation:
Toronto Western Hospital
P. Emanuela Voinescu
Affiliation:
Brigham & Women's Hospital, Boston, MA
Get access

Summary

Most women with epilepsy can have a normal pregnancy without change in seizure control. There is increased risk for some adverse pregnancy outcomes for which women with epilepsy should be followed closely by medical and obstetrical teams. Increased drug clearance is observed for several anti-seizure medications (ASM) during pregnancy. Therapeutic drug monitoring is recommended to guide dose adjustments of ASM to maintain seizure control. This chapter discusses how seizure management may be optimized.

Type
Chapter
Information
Women with Epilepsy
A Practical Management Handbook
 , pp. 215 - 230
Publisher: Cambridge University Press
Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schmidt, D, Canger, R, Avanzini, G, et al. Change of seizure frequency in pregnant epileptic women. J Neurol Neurosurg Psychiatry. 1983;46(8):751–5.CrossRefGoogle ScholarPubMed
Bag, S, Behari, M, Ahuja, GK, Karmarkar, MG. Pregnancy and epilepsy. Journal of Neurology. 1989;236:311–13.CrossRefGoogle ScholarPubMed
Battino, D, Tomson, T, Bonizzoni, E, et al. Seizure control and treatment changes in pregnancy: Observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013;54:1621–7.CrossRefGoogle ScholarPubMed
La Neve, A, Boero, G, Francavilla, T, et al. Prospective, case-control study on the effect of pregnancy on seizure frequency in women with epilepsy. Neurol Sci. 2014;36:79–83.CrossRefGoogle ScholarPubMed
Thomas, SV, Syam, U, Devi, JS. Predictors of seizures during pregnancy in women with epilepsy. Epilepsia. 2012;53:e85–e88.CrossRefGoogle ScholarPubMed
Pennell, PB, French, JA, May, RC, et al. Changes in seizure frequency and antiepileptic therapy during pregnancy. New England Journal of Medicine. 2020;383(26):2547–56.CrossRefGoogle ScholarPubMed
Burakgazi, E, Pollard, J, Harden, C. The effect of pregnancy on seizure control and antiepileptic drugs in women with epilepsy. Reviews in Neurological Diseases. 2011;8:16–22.Google ScholarPubMed
Vajda, FJE, O’Brien, TJ, Graham, JE, et al. Predicting epileptic seizure control during pregnancy. Epilepsy & Behavior. 2018;78:91–5.CrossRefGoogle ScholarPubMed
Shahla, M, Hijran, B, Sharif, M. The course of epilepsy and seizure control in pregnant women. Acta Neurol Belg. 2018;118(3):459–64.CrossRefGoogle ScholarPubMed
Mostacci, B, Troisi, S, Bisulli, F, et al. Seizure worsening in pregnancy in women with sleep-related hypermotor epilepsy (SHE): A historical cohort study. Seizure. 2021;91:258–62.CrossRefGoogle Scholar
Voinescu, PE, Ehlert, AN, Bay, CP, Allien, S, Pennell, PB. Variations in seizure frequency during pregnancy and postpartum by epilepsy type. Neurology. 2022;98:e802–e807.CrossRefGoogle ScholarPubMed
Sveberg, L, Svalheim, S, Taubøll, E. The impact of seizures on pregnancy and delivery. Seizure. 2015;28:35–8.CrossRefGoogle ScholarPubMed
Cagnetti, C, Lattanzi, S, Foschi, N, Provinciali, L, Silvestrini, M. Seizure course during pregnancy in catamenial epilepsy. Neurology. 2014;83(4):339–44.CrossRefGoogle ScholarPubMed
Eadie, MJ. Treating epilepsy in pregnant women. Expert Opinion on Pharmacotherapy. 2014;15:841–50.CrossRefGoogle ScholarPubMed
Voinescu, P, Park, S, Chen, L, et al. Antiepileptic drug clearances during pregnancy and clinical implications for women with epilepsy. Neurology. 2018;91:e1228–e1236.CrossRefGoogle ScholarPubMed
Pennell, PB, Karanam, A, Meador, KJ, et al. Antiseizure medication concentrations during pregnancy: Results from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study. JAMA Neurol. 2022;79(4):370–9.CrossRefGoogle ScholarPubMed
Tomson, T, Battino, D, Bromley, R, et al. Management of epilepsy in pregnancy: A report from the International League against Epilepsy Task Force on Women and Pregnancy. Epileptic Disorders. 2019;21(6) 497–517.CrossRefGoogle ScholarPubMed
Polepally, AR, Pennell, PB, Brundage, RC, et al. Model‐based lamotrigine clearance changes during pregnancy: Clinical implication. Ann Clin Transl Neurol. 2014;1(2):99–106.CrossRefGoogle ScholarPubMed
Petrenaite, V, Sabers, A, Hansen-Schwartz, J. Seizure deterioration in women treated with oxcarbazepine during pregnancy. Epilepsy Research. 2009;84(2):245–9.CrossRefGoogle ScholarPubMed
Johannessen Landmark, C, Farmen, AH, Burns, ML, et al. Pharmacokinetic variability of valproate during pregnancy: Implications for the use of therapeutic drug monitoring. Epilepsy Res. 2018;141:31–7.CrossRefGoogle ScholarPubMed
Fukushima, Y, Yamamoto, Y, Yamazaki, E, et al. Change in the pharmacokinetics of lacosamide before, during, and after pregnancy. Seizure. 2021;88:12–14.CrossRefGoogle Scholar
Edey, S, Moran, N, Nashef, L. SUDEP and epilepsy-related mortality in pregnancy. Epilepsia. 2014;55(7):e72–4.CrossRefGoogle ScholarPubMed
Christensen, J, Vestergaard, C, Hammer Bech, B. Maternal death in women with epilepsy: Smaller scope studies. Neurology. 2018;91(18):e1716–e1720.CrossRefGoogle ScholarPubMed
MacDonald, SC, Bateman, BT, McElrath, TF, Hernández-Díaz, S. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol. 2015;72(9):981–8.CrossRefGoogle ScholarPubMed
Tanaka, H, Katsuragi, S, Hasegawa, J, et al. Maternal death related to sudden unexpected death in epilepsy: A nationwide survey in Japan. Brain Sci. 2021;11(8):995.CrossRefGoogle ScholarPubMed
Pennell, P. Pregnancy, epilepsy, and women’s issues. Continuum. 2013;19:697–714.Google ScholarPubMed
Viale, L, Allotey, J, Cheong-See, F, et al. Epilepsy in pregnancy and reproductive outcomes: A systematic review and meta-analysis. Lancet. 2015;386:1845–52.CrossRefGoogle ScholarPubMed
Chen, Y, Chiou, H, Lin, H, Lin, H. Affect of seizures during gestation on pregnancy outcomes in women with epilepsy. Archives of Neurology. 2009;66:979–84.CrossRefGoogle ScholarPubMed
Rauchenzauner, M, Rauchenzauner, M, Ehrensberger, M, et al. Generalized tonic-clonic seizures and antiepileptic drugs during pregnancy: A matter of importance for the baby? J Neurol. 2013;260:484–8.CrossRefGoogle ScholarPubMed
Cummings, C, Stewart, M, Stevenson, M, Morrow, J, Nelson, J. Neurodevelopment of children exposed in utero to lamotrigine, sodium valproate and carbamazepine. Archives of Disease in Childhood. 2011;96:643–7.CrossRefGoogle ScholarPubMed
Adab, N, Kini, U, Vinten, J, et al. The longer term outcome of children born to mothers with epilepsy. Journal of Neurology, Neurosurgery & Psychiatry. 2004;75:1575–83.CrossRefGoogle ScholarPubMed
Minkoff, H, Schaffer, RM, Delke, I, Grunebaum, AN. Diagnosis of intracranial hemorrhage in utero after a maternal seizure. Obstet Gynecol. 1985; 65: 22S–4S.Google ScholarPubMed
Loring, DW, Meador, KJ, Lee, GP. Determinants of quality of life in epilepsy. Epilepsy & Behavior. 2004;5(6):976–80.CrossRefGoogle ScholarPubMed
Tomson, T, Battino, D, Craig, J, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: A prospective cohort study of the EURAP registry. Lancet Neurology. 2018;17:530–8.CrossRefGoogle ScholarPubMed
Tomson, T, Battino, D, Bonizzoni, E, et al. Withdrawal of valproic acid treatment during pregnancy and seizure outcome: Observations from EURAP. Epilepsia. 2016;57(8):e173–e177.CrossRefGoogle ScholarPubMed
Vajda, FJE, O’Brien, TJ, Graham, JE, et al. Pregnancy after valproate withdrawal: Fetal malformations and seizure control. Epilepsia. 2020;61(5):944–50.CrossRefGoogle ScholarPubMed
Asranna, A, Jose, M, Philip, RM, Sarma, PS, Thomas, SV. Do anti-epileptic drug modifications after first trimester of pregnancy influence fetal malformation or cognitive outcome? Epilepsy Research. 2018;146:121–5.CrossRefGoogle ScholarPubMed
Harden, CL, Pennell, PB, Kaplan, PW, et al. Practice parameter update: Management issues for women with epilepsy. Focus on pregnancy (an evidence-based review). Vitamin K, folic acid, blood levels, and breastfeeding. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73(2):142–9.Google Scholar
Pirie, DAJ, Wattar, BHA, Pirie, AM, et al. Effects of monitoring strategies on seizures in pregnant women on lamotrigine: A meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2013;172:26–31.CrossRefGoogle ScholarPubMed
Thangaratinam, S, Marlin, N, Newton, S, et al. AntiEpileptic drug monitoring in PREgnancy (EMPiRE): A double-blind randomised trial on effectiveness and acceptability of monitoring strategies. Health Technol Assess. 2018;22(23):1–152.CrossRefGoogle ScholarPubMed
EURAP Study Group. Seizure control and treatment in pregnancy: Observations from the EURAP epilepsy pregnancy registry. Neurology. 2006;66(3):354–60.Google Scholar
Katz, JM, Devinsky, O. Primary generalized epilepsy: A risk factor for seizures in labor and delivery? Seizure. 2003;12(4):217–19.CrossRefGoogle ScholarPubMed
Bollig, KJ, Jackson, DL. Seizures in pregnancy. Obstetrics and Gynecology Clinics of North America. 2018;45(2):349–67.CrossRefGoogle ScholarPubMed
Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial. Lancet. 1995;345:1455–63.Google Scholar
Lu, Y, Hsu, C, Tsai, W, et al. Status epilepticus associated with pregnancy: A cohort study. Epilepsy & Behavior. 2016;59:92–7.CrossRefGoogle ScholarPubMed
Rajiv, KR, Radhakrishnan, A. Status epilepticus in pregnancy: Can we frame a uniform treatment protocol? Epilepsy & Behavior. 2019;101:106376.CrossRefGoogle Scholar
Kusznir Vitturi, B, Barreto Cabral, F, Mella Cukiert, C. Outcomes of pregnant women with refractory epilepsy. Seizure. 2019;69:251–7.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×