I am an epileptic and want to have a child. Can I stop taking medication?

Epilepsy itself, as well as long-term use of anti-epileptic drugs, may have varying degrees of impact on the fetus. So what should mothers with epilepsy who are preparing to become pregnant do?

Can I stop taking anti-epileptic drugs when preparing for pregnancy?

Before pregnancy, you should ensure that you have not had an epileptic seizure for at least the past six months. Whether you can stop taking the medication depends on the individual situation of the patient. If epilepsy still occurs continuously, you must not stop taking the medication. If the patient has not had an attack for the past two to three years and the EEG is normal, you can consider gradually stopping the medication. The doctor needs to evaluate the condition. The vast majority of epilepsy patients need to continue taking anti-epileptic drugs during pregnancy to avoid adverse effects on pregnancy and the fetus due to epileptic seizures.

Choice of epilepsy medication during pregnancy

Antiepileptic drugs may increase the potential risk of adverse events such as miscarriage, congenital malformations, intrauterine growth restriction, and bleeding during delivery. Safer antiepileptic drugs should be selected as much as possible, and monotherapy should be used as much as possible, and the lowest effective maintenance dose should be used. The combined use of multiple drugs will significantly increase the risk of teratogenicity. Because pregnancy may cause changes in drug clearance, it is necessary to regularly monitor the blood concentration of antiepileptic drugs during pregnancy, adjust the drug dosage in a timely manner, and regularly monitor the growth and development of the fetus.

The safer anti-epileptic drugs that can be used during pregnancy include lamotrigine, levetiracetam, oxcarbazepine, gabapentin, topiramate, and ethosuximide. Among them, lamotrigine is best tolerated by the fetus and is the first choice for planning pregnancy and during pregnancy. The teratogenic risk of several other drugs is relatively small, but regular monitoring should also be noted during pregnancy. For example, monotherapy with topiramate in early pregnancy can cause malformations such as skeletal abnormalities of the extremities, congenital heart disease, and cleft lip and palate.

Sodium valproate, carbamazepine, phenobarbital, phenytoin and primidone should be avoided as these drugs have a relatively high risk of teratogenicity. Valproic acid should be strictly avoided in women of childbearing age and during pregnancy, and should only be used when other anti-epileptic drugs are ineffective. Valproic acid has a high risk of teratogenicity, increasing the risk of teratogenicity by 2-4 times, and can cause neural tube defects, lumbar spina bifida, and limb defects on the inner side of the upper limbs.

Other antiepileptic drugs, such as lacosamide and pregabalin, are not recommended during pregnancy due to lack of experience.

During pregnancy, women taking anti-epileptic drugs should increase folic acid supplementation

Taking anti-epileptic drugs can lead to a decrease in human folic acid, so patients with epilepsy should pay attention to folic acid supplementation. It is recommended that patients with epilepsy increase folic acid supplementation during the pregnancy preparation stage. During the pregnancy preparation stage and early pregnancy (first 3 months), a high dose of folic acid of 5 mg/d can be taken orally daily to reduce the risk of congenital malformations in the fetus to a certain extent.

Vitamin K1 should be supplemented before delivery to prevent neonatal bleeding

Newborns and premature infants often show vitamin K deficiency, so it is necessary to prevent fetal postpartum hemorrhage. In addition, anti-epileptic drugs such as carbamazepine, oxcarbazepine, phenobarbital, phenytoin sodium, and topiramate can pass through the placenta to promote the oxidative degradation of vitamin K1 in the fetus, leading to an increased risk of neonatal hemorrhagic diseases. Therefore, it is recommended that mothers take 20 mg of vitamin K1 orally every day in the last month of pregnancy to reduce the risk of fetal hemorrhagic diseases.

The dosage of anti-epileptic drugs should be adjusted after delivery, and the adverse reactions of the fetus should be observed.

After a pregnant woman with epilepsy gives birth, she needs to gradually reduce the dose of anti-epileptic drugs to pre-pregnancy levels within a few weeks. All anti-epileptic drugs will enter breast milk to a greater or lesser extent. In most cases, if only one anti-epileptic drug is used, breastfeeding can continue. If an anti-epileptic drug is used during pregnancy and is stable and effective, it can continue to be used during breastfeeding, and do not change the drug suddenly. The medication time should be staggered with the breastfeeding time, and the interval should be as long as possible. If the infant repeatedly experiences the following symptoms that cannot be explained by other reasons, such as sedation, weakened sucking power, and restlessness, the concentration of anti-epileptic drugs in the infant's serum should be tested to decide whether to interrupt breastfeeding or supplement with infant formula.

Therefore, pregnant mothers with epilepsy should not be too nervous. They should control their epilepsy before preparing for pregnancy, choose relatively safe anti-epileptic drugs, and have regular check-ups during pregnancy. You can still have a healthy and smart baby.

References:

［1］ Schaefer, Christof Schaefer, Paul WJ Peters, Richard K Miller. (2015, Third edition). Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment[M]. Pittsburgh: Academic Press.

[2] Epilepsy Committee of the Neurology Branch of the Chinese Medical Doctor Association. Chinese expert consensus on the use of anti-epileptic drugs in pregnant women. Chinese Journal of Physicians. 2015, 17(7):969-971.