The management of epilepsy in pregnancy

Authors

  • SP Walker,

    1. Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Vic., Australia
    2. Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic., Australia
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  • M Permezel,

    1. Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Vic., Australia
    2. Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic., Australia
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  • SF Berkovic

    1. Department of Medicine and Epilepsy Research Centre, University of Melbourne, Austin Health, Heidelberg West, Vic., Australia
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Assoc. Prof Sue Walker, Department of Perinatal Medicine, Mercy Hospital for Women, 163 Studley Road, Heidelberg, Vic. 3084, Australia. Email: spwalker@unimelb.edu.au

Abstract

While most women with epilepsy can expect a normal pregnancy outcome, epilepsy remains a significant contributor to both maternal and perinatal morbidity. Pre-pregnancy planning must address reliable contraception and optimisation of antiepileptic drug (AED) regimens to minimise teratogenic risk while maintaining seizure control. The most recent data from the AED registries regarding malformations is presented in this review, as is the limited data on the newer AEDs and studies linking neurocognitive outcomes to AED exposure. During pregnancy, important considerations include; therapeutic drug monitoring, surveillance for obstetric complications and vigilance for seizures during the intrapartum and postpartum period.

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