The uncertainty as to whether one can become pregnant with known epilepsy affects many women. The question of heredity, side effects of drugs and harm to the child in the event of an epileptic seizure during pregnancy are often the most pressing issues. As a rule, epilepsy does not rule out pregnancy.
Ideally, however, the pregnancy should be planned and the specifics during pregnancy discussed with the treating neurologist and gynecologist in order, on the one hand, to eliminate the greatest worries and, on the other hand, to reduce the existing risks. This can be done by adjusting the current medication, regular blood tests and preventive and ultrasound examinations. As a rule, pregnancies with a known epilepsy then proceed without complications.
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The use of anti-epileptic drugs increases the risk of malformations three times compared to children of healthy mothers who are not taking medication. Clinical studies have shown that monotherapy, i.e. taking only one drug, significantly reduces the risk compared to combination therapies. These should therefore be avoided as far as possible. In addition, the lowest effective daily dose should be determined and the drug should be taken evenly distributed throughout the day in order to avoid high concentration peaks in the blood. Combination therapies in particular, but sometimes also monotherapy, can lead to a decrease in the folic acid concentration. This decrease increases the risk of skull cracking and neural tube defects. For this reason, folic acid should be taken daily, especially in the first trimester of pregnancy.
Under these conditions, any anti-epileptic can in principle be taken during pregnancy. In the first three months, however, the intake of valproic acid should be avoided if possible, as this therapy results in the highest rate of malformations. However, since valproic acid is particularly effective in generalized epilepsy and can hardly be avoided, daily doses of at least 1000 mg and blood levels of 80 mg / l should not be exceeded.
Enzyme-reducing antiepileptic drugs (e.g. phenytoin, phenobarbital, primidone, carbamazepine) can lead to coagulation disorders and thus an increased tendency to bleed, which in the worst case can trigger cerebral haemorrhage in the child and abdominal bleeding in the mother during or shortly after birth. To avoid this, the mother should be given vitamin K shortly before the birth and the child shortly after.
Phenytoin and phenobarbital can lead to a deficiency in vitamin D. A diet containing vitamin D and sufficient sun can prevent this deficiency.
In any case, it should be noted that the maternal body may work differently during pregnancy. This means that the drugs can be absorbed or broken down better or worse, which affects the concentration of the drug in the blood. In order to prevent overdosing or underdosing of the respective antiepileptic drug, blood tests should be carried out regularly.
Lamotrigine is the drug of choice for focal epilepsy with and without secondary generalization, primary generalized seizures, and treatment-resistant seizures. It is preferred for depressed patients with seizure disorders. The advantages are that it does not have a calming and soporific effect and increases intellectual performance. Overall, lamotrigine has few side effects and is not harmful to the unborn child and is therefore the first choice for pregnancy. The only serious side effect is Steven Johnson Syndrome (acute skin rashes).
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Drugs for epilepsy increase the risk of malformations in the unborn child about three times. Malformations of the face and the extremities of the fingers, growth delays during pregnancy and developmental disorders of the central nervous system occur more frequently, especially when taking classic anti-epileptic drugs (valproic acid, carbamazepine, phenobarbital, phenytoin). About every 5th to 10th child in whom this medication was taken during pregnancy is affected by at least one of these abnormalities. With the exception of lamotrigine (see above), there is not yet sufficient data for the newer anti-epileptic drugs to be able to estimate the risk.
After birth, after-effects of the medication on the newborn can occur for a few months. The calming effect of many medications can last up to a week and can manifest itself in the child as drowsiness, poor drinking and decreased muscle tension. Withdrawal symptoms can last from a few days to several months and show up, for example, as frequent screaming, severe restlessness, vomiting, diarrhea or increased muscle tension. In addition, a smaller head circumference is often observed in the newborn, especially after taking primidone and phenobarbital.
Malformations of varying degrees in the child in pregnant women with epilepsy are two to three times as common as the population average. The so-called “major” malformations in children are heart defects, cleft lip and palate and spina bifida (cleft back). These malformations are usually due to the antiepileptic therapy and the type of seizures during pregnancy. In order to avoid malformations, therapy should be sought before pregnancy that both prevents seizures in the expectant mother and has the least possible harmful effect on the child.
It is not yet clear whether seizures during pregnancy harm the unborn child. Serious injuries to the mother caused by an attack are very likely to pose a threat to the child, especially if they are in the abdominal region.
Long-term seizures also have a negative effect on the unborn child. During these seizures, the child's heart rate drops, which can lead to a lack of oxygen. Status epilepticus in particular, i.e. an attack that lasts longer than five minutes or several attacks that occur at short intervals, can be life-threatening for both mother and child. However, this occurs very rarely during pregnancy and if emergency therapy is initiated quickly it rarely leads to termination of pregnancy.
Epilepsy in the narrower sense is rarely inherited. Inheritance depends on the type of epilepsy and in most cases is not a hereditary disease in the narrower sense. Nevertheless, genetic factors play a certain role, as children whose parents have epilepsy are more likely to have seizures. However, in order to actually develop epilepsy in the course of life, many other factors play a role, so that only about 3-5% of children develop epilepsy. It is very likely that this epilepsy is a benign, relatively easily treatable epilepsy. However, it is noticeable that children in whom both parents are affected by epilepsy have a significantly higher risk of the disease.
Monogenic epilepsies, i.e. epilepsies that occur due to the mutation of a single gene and can be inherited through this, are less common. One example is benign familial neonatal epilepsy. This starts around the 2nd or 3rd day of life, can be treated relatively well and often ends on its own.
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The doctor can issue an employment ban if there is a risk to the health of mother and child. This prohibition is not generally issued in the case of epilepsy, but must be checked on a case-by-case basis. Sleep deprivation or stress due to work (both factors that can lead to an epileptic seizure) can be reasons to ban you from employment. These factors should always be discussed with the attending physician and weighed up whether there is a risk.
