Treatment Dilemmas in Women With Epilepsy

By Dr. Vivek Kumar in Neurosciences

Jul 26 , 2017 | 2 min read

There are about 50 million people with epilepsy worldwide and half of them are women. About a sixth of women with epilepsy in the world are in India. In India, there are about 2.73 million WWE (Women with Epilepsy) and 52% of them are in reproductive (15- 49) age group. It has also been estimated that three to five births per thousand will be to WWE. Social stigma, marriage and child-rearing were seen as inappropriate for women with epilepsy. These unfortunate and misguided attitudes were often based on the following mistaken ideas:

  • Epilepsy is always inherited
  • The treatment of women with epilepsy has a negative impact on child-rearing. This is untrue. More than 90% of women with epilepsy have healthy babies without seizure disorders and they lead healthy and active lives.

What is Reproductive Counselling?

  • Counselling should be sought either before marriage or planning pregnancy.
  • Every WWE is reassessed for confirming the diagnosis of epilepsy.
  • Those who are in remission (seizure free for 2-3 years) are considered for antiepileptic drug withdrawal. The risk of recurrence on suddenly stopping the treatment should be explained.
  • The risk of major congenital malformations is 6-8%, more common in women on high doses of antiepileptic drugs (AEDs) or multiple AEDs.
  • Risk can be reduced by using most appropriate drug in smallest effective dose and avoiding polytherapy unless absolutely required.
  • It is not safe to abruptly discontinue medicine during pregnancy.
  • Low serum or red cell folate levels are associated with spontaneous abortion and neural tube defects.
  • Hence it is recommended to give 5 mg of folic acid to all WWE on AED and planning for pregnancy and should continue throughout the pregnancy.
  • WWE who smoke has higher risk of premature labour and delivery.

Breast Feeding

In a recent prospective study showed that there was no difference between infants who are exposed to AEDs through breast milk and those who were not exposed, with regards to the IQ at 3 yrs of age.

It is recommended that mothers first nurse the babies and then consume the AEDs so that blood levels will not be very high during breast feeding.

It is advised to nurse the baby in such a way that in the event of a seizure, they would not drop the baby or suffocate her.

Dr Vivek Kumar says Epilepsy Management options should be discussed with a neurologist before planning a pregnancy. Its treatment should not be stopped suddenly. Moreover, more than 90% of infants born to mothers on AEDs remain healthy. The risk of major malformations is 6-8%, mostly in those who are on higher doses or polytherapy. So it is better to rationalise the AED therapy with the neurologist before planning your pregnancy.