Managing epilepsy in women of childbearing age — Polish Society of Epileptology and Polish Gynecological Society Guidelines

Abstract

Epilepsy is the most common neurological disorder during pregnancy [1]. About one-third of women with epilepsy are of childbearing age. Statistically, between 0.3% and 0.5% of births occur in women with epilepsy [2]. Every year in Poland epilepsy poses a threat to the health of some 1800 pregnant women and their fetuses. According to British studies, the risk of death in pregnant women with epilepsy increases tenfold compared to pregnant women without epilepsy, mainly due to sudden unexpected death in epilepsy (SUDEP) [3]. Diagnostic and therapeutic advances in the field of epilepsy have contributed to better seizure control. As a result, more and more women with epilepsy become pregnant and more than 90% give birth to healthy children [4,5]. In order to avoid irregularities in the management of women suffering from epilepsy, it is very important to create standards for the management of women treated for epilepsy, both for those who are already pregnant and those who plan pregnancy. Thus the first edition of guidelines regarding management and care in women with epilepsy during preconception period and also during pregnancy, delivery, and postpartum were prepared by the experts of Polish Society of Epileptology and Polish Gynecological Society. The diagnosis, seizures classification and therapy of epilepsy were not included into the guidelines.The neurologists, gynecologists and family doctors should inform that the women with epilepsy could benefit from planning pregnancies to reduce the risk of fetal congenital malformations. Due to increased awareness and knowledge concerning epilepsy, the number of planned pregnancies is increasing, but 40% are still unplanned. The risk of major congenital malformations in the fetus increases in women with epilepsy taking antiepileptic drugs [6]. Fears of women with epilepsy in relation to the adverse effects of antiepileptic drugs on infants can lead to arbitrary withdrawal or dose reduction of antiepileptic drugs, and thus increase the risk of seizures and even SUDEP [4]. Therefore, women of reproductive age (15-44 years) treated for epilepsy should receive care from specialist epilepsy and gynecology clinics. DIAGNOSIS OF EPILEPSYEpilepsy is a heterogeneous group of diseases of the brain, the common symptoms of which are clinical seizures. After diagnosis of epilepsy, a neurologist determines the type of epileptic seizure and suggests appropriate treatment for epilepsy. Based on the course of the disease, neurologist can assess the degree of risk of neurological complications in pregnancy. Women who have not experienced seizures for at least 10 years (including five years without antiepileptic drugs) and those who were diagnosed with childhood epileptic syndrome, but have not experienced seizures in

Antiepileptic Drug Treatment Patterns in Women of Childbearing Age With Epilepsy

“…Additional education is needed to increase the awareness of the teratogenicity risks and women should participate in AED selection based on comprehensive information. 39,40 The efficacy of the medical and patient information program can be assessed by monitoring AED prescription patterns in a population-based cohort.…”

Polish Society of Gynecologists and Obstetricians recommendations on supplementation in pregnancy

“…Relevant environmental risk factors for NTD include: pregestational diabetes (risk 2-10 times higher), BMI > 30 (risk 1.4-3.5 higher), use of antiepileptic drugs (carbamazepine and valproic acid are associated with 1-2% of NTD risk), genetic conditions-neural tube defects in previous pregnancy or in a family history [66][67][68][69][70].…”

Recommendations of the Polish Society of Gynecologists and Obstetricians regarding caesarean sections

“…By itself, it is not an indication for caesarean section and most women with good disease control can have a vaginal delivery. Only a small number of pregnant women who have recurrent and prolonged seizures during pregnancy and who are at a high risk of developing an epileptic state may be eligible for an elective caesarean section [57].…”