24. Epilepsy

  1. John T. Queenan MD4,
  2. Catherine Y. Spong MD5 and
  3. Charles J. Lockwood MD6
  1. Autumn M. Klein MD, PhD1,2 and
  2. Page B. Pennell MD2,3

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch24

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Klein, A. M. and Pennell, P. B. (2012) Epilepsy, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch24

Editor Information

  1. 4

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 5

    Bethesda, MD, USA

  3. 6

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. 1

    Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA

  2. 2

    Harvard Medical School, Boston, MA, USA

  3. 3

    Division of Epilepsy, EEG and Sleep Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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Keywords:

  • epilepsy, chronic brain disorder of various etiologies;
  • seizures in pregnancy, physiologic, psychosocial adjustments;
  • continuous treatment during pregnancy, and AEDs;
  • planned pregnancies with AED optimization;
  • fetal anticonvulsant syndrome, intrauterine growth retardation;
  • birth control for women, antiepileptic drug monotherapies;
  • MCM with AED exposure, and hormonal contraceptive agents;
  • prenatal screening, in “anticonvulsant embryopathy”;
  • preconceptional planning and multidisciplinary management

Summary

Epilepsy is a chronic brain disorder of various etiologies characterized by recurrent, unprovoked seizures. A seizure is caused by paroxysmal abnormal cerebral neuronal discharges. Clinical manifestations are stereotyped, episodic alterations in behavior or perception. Epilepsy can begin at any age of life, and two-thirds of cases are idiopathic. The prevalence is approximately 0.64% in the United States. Epilepsy is the most common neurologic disorder that requires continuous treatment during pregnancy, and antiepileptic drugs are one of the most frequent chronic teratogen exposures. Over one million women with epilepsy in the United States are in their active reproductive years and give birth to over 24,000 infants each year. However, it is estimated that the total number of children in the United States exposed in utero to antiepileptic drugs is nearly twice that amount with the emergence of antiepileptic drug use for other illnesses including headache, chronic pain, and mood disorders. Many of the principles outlined below about antiepileptic drug use during pregnancy can be extrapolated to women with any disorder treated with these agents. Although some of the other disorders may allow for discontinuation of the antiepileptic drug during pregnancy unlike most epilepsy cases, pregnancies are often not identified until after organogenesis occurs. The vast majority of women with epilepsy will have a normal pregnancy with a favorable outcome, but there are increased maternal and fetal risks compared to the general population. Careful management of any pregnancy in a woman with epilepsy is essential to minimize these risks, ideally beginning with preconceptional planning.