When we talk about epilepsy and pregnancy, in the office we usually face two scenarios: The best scenario is that of the patient who wants to plan the pregnancy. The other is when the patient is already pregnant, without prior planning.
In all cases, we must know that the best predictor of good control of epileptic seizures during pregnancy is good control prior to pregnancy. That is to say, the more controlled the seizures of the pregnant woman are in the pre-gestation stage, the better the result will be during pregnancy with respect to those patients who cannot control the seizures.
What are the crises that represent the greatest risk?
The seizures that represent a greater risk, both for the mother and the unborn baby, are the generalized tonic-clonic seizures, which are characterized by sudden jerks of the whole body. Focal seizures with evolution to bilaterality are those that begin in one part of the body and then spread to the other side. These are the ones that cause a decrease in the oxygen that reaches the baby through the placenta and are the ones most associated with falls and trauma.
What are the causes of increased seizures in pregnancy?
In principle, lhe main causes of increased seizures during pregnancy are due to lack of adherence to antipileptic treatment, either due to fear of its effects, bad previous experience or lack of medical advice. Another important cause is the alteration in the blood levels of the medication, although this is secondary to an increase in the body water of the pregnant woman, which causes the drug to be “diluted” more, to an increase in body fat that makes that many drugs we use are stored there and do not fulfill their optimal effect, and due to an accelerated increase in urine elimination of it.
The most appropriate way to prevent a decrease in the dose is to carry out periodic controls to the specialist and carry out dosages of the drugs in the blood, in order to adjust them throughout the pregnancy.
Other factors to take into account are teratogenic, that is, those that can cause abnormalities in the unborn baby, and we know that those drugs that are most at risk are valproic acid, carbamazepine, phenobarbital and phenytoin.
- Avoid valroic acid, phenytoin, carbamazepine, and phenobarbital whenever possible.
- Take the medication properly.
- Start the intake of folic acid.
- Carry out regular check-ups with the neurologist to be able to adjust drug levels as the pregnancy progresses.
- Breastfeeding is always recommended, despite anticonvulsant treatment. There are some treatments in which we must be careful such as: phenobarbital, ethosuccimide and felbamate.
During the delivery:
- Bear in mind that the diagnosis of epilepsy is NOT an indication for caesarean section.
More than 95% of vaginal deliveries occur without problems, without crisis during delivery or in the first 24 hours after delivery.