Epilepsy in pregnancy. It's a complicated issue, but epilepsy, seizures, are common. How to manage the best epilepsy during pregnancy? What are the issues to think about for women with epilepsy if they consider becoming pregnant? It's certainly important to have a clinic beforehand, before discontinuing contraception, or before planning a pregnancy with assisted medical reproductive techniques. It's important to have a clinic with a specialist in epilepsy, the neurologist, and obstetrician. In some cases, an obstetrician specialized in neurological disorders is needed. An epilepsy specialist familiar with managing pregnancy may be needed. But not in all cases! For example, a patient may have idiopathic epilepsy with generalized seizures that are well controlled with a medication, which is well tolerated during pregnancy, such as Lamictal. If a patient had no seizures in the year before pregnancy, things would probably go very smoothly throughout pregnancy. However, it is necessary to discuss a few things beforehand. First, the patients are very keen on having data regarding the safety of the anti-seizure medicines they are taking. If we consider Lamictal, there is a lot of reassuring data on safety. Dr. Anton Titov, MD. So this is an easy question to answer, but it needs to be answered. Dr. Anton Titov, MD. There is the question of breastfeeding with Lamictal, and it's very controversial. Some doctors advocate for breastfeeding while on Lamictal. They say that in studied patient cohorts, there is no difference regarding the health of a child between breastfeeding mothers and non-breastfeeding mothers who take Lamictal. Other doctors say, 'Let's be prudent and let's avoid giving any neurological drug to a developing brain when it is possible not to give it. Dr. Marc Dommergues. Medical second opinion. And let's prefer to avoid breastfeeding to give as little as possible Lamictal to this developing brain. Dr. Marc Dommergues. I would rather be in the latter category. But I know this is quite controversial. Dr. Marc Dommergues. I do admit that another opinion is understandable. Dr. Marc Dommergues. We talked about epilepsy medications and pregnancy. Another question is, what is the goal during pregnancy from a neurological point of view? I'd like to make a long story short and to say things in an over simplified view. You know, I am an obstetrician. Dr. Anton Titov, MD. So as an obstetrician, I like to oversimplify by nature. The goal during pregnancy is to avoid status epilepticus, which is very dangerous. How are we going to achieve that? First, by having close clinical monitoring of epilepsy. This can be achieved by seeing a neurologist a few times during pregnancy. Obstetricians should ask very simple questions. How does a pregnant woman feel? Does she have any seizures? Does she have symptoms making her think she might have a seizure in the future? Then if there are symptoms or signs that show a change in her clinical condition, the second step will be to check the anti-seizure drug concentration in her blood. A neurologist may decide to increase the dose of anti-epileptic medication. All these steps are rather simple. Regarding the delivery of the baby, it will be important to limit stress before delivery because stress is known to be able to trigger seizures. Treating pain during labor and delivery adequately is very important. Some women with epilepsy benefit from epidural anesthesia. Sometimes it may be useful to induce labor a little bit earlier. Especially it's true in cases where a woman may feel very tired. She may tell us, 'I feel on the verge of having a seizure. A seizure doesn't come, but really I don't feel comfortable'. If a woman is at 39 weeks of pregnancy, induction of labor is an option.
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