New Guideline Published for Epilepsy Management in People Who May Become Pregnant

A new guideline was published in Neurology, providing guidance to health care providers regarding the use of antiseizure medications in people with epilepsy who may become pregnant. The guideline was developed collaboratively by the American Academy of Neurology (AAN), the American Epilepsy Society (AES), and the Society for Maternal-Fetal Medicine (SMFM). The guideline partly updates guidance from 2009 on epilepsy management during pregnancy and the risks of treatment, which were published by the AAN and AES.

The new guideline, which was developed based on a comprehensive literature review, takes pregnancy risks into consideration, including:

• Major congenital malformations
• Birth defects
• Fetal growth issues
• Neurodevelopmental effects

According to a statement from the AAN, the guideline suggests that, at the earliest possible opportunity before pregnancy, health care providers “recommend medications and doses that optimize both seizure control and fetal development.” During pregnancy, health care providers should work to minimize seizure occurrence, including the increase in seizure frequency associated with the cessation of anti-seizure medications. The guideline recommends medications such as lamotrigine, levetiracetam, and oxcarbazepine, and advises against medications associated with pregnancy and neurodevelopmental complications, including valproic acid, phenobarbital, and topiramate. Additionally, the guideline states that the daily use of folic acid before and during pregnancy may decrease the risk of neural tube defects and improve neurodevelopmental outcomes.

“Most children born to people with epilepsy are healthy, but there is a small risk of pregnancy-related problems, partly due to seizures and partly due to the effects of antiseizure medications,” said Alison M. Pack, MD, MPH, author of the published guidelines. “This guideline provides recommendations regarding the effects of antiseizure medications and folic acid supplementation on malformations at birth and the development of children during pregnancy so that doctors and people with epilepsy can determine which treatments may be best for them.”

The Child Neurology Society endorsed the published guidelines.