Management of women with epilepsy during child-bearing years requires complex decision-making, with the goal of optimal maternal seizure control balanced against potential fetal risks of in utero anti-epileptic drug exposure. An abundance of data is now available to differentiate risks between some AEDs with regard to both structural teratogenecity and neurodevelopmental consequences. However, evidence is still lacking regarding many of the AEDs overall, and details of how best to dose AEDs during critical time windows to optimize maternal and fetal outcomes is an area of active research. Peripartum is a particularly vulnerable time for seizure worsening; data is now available to support the benefits of breastfeeding in women with epilepsy on AEDs but sleep disruption can worsen seizures in many. This session provides the latest data available regarding these issues, as well as delve into some of the more contemporary controversies including when use of valproate is justifiable in this special patient population, dosing strategies, and when therapeutic drug monitoring should be used and alternative strategies when it is not available.
Following participation in this session, learners should be able to:
- List the antiepileptic drugs (AED) that carry relatively higher teratogenic risk (structural and neurodevelopmental).
- Review and discuss how each AED does or does not increase the teratogenic risk.
- Describe gestational pharmacokinetic principles and restate how to adjust medications during pregnancy to maintain seizure control, as well as in the postpartum period.
- Delineate approaches for counseling women regarding strategies to lower seizure risk during the peripartum period.
- Recognize and describe the neurodevelopmental risks of children born to women with epilepsy, with specific considerations of contributory factors that include family history, vitamin use, AED type and dose, and maternal seizure control as well as other obstetric and neonatal complications.
- Identify the neurocognitive profiles to monitor during early child development.
Basic and Intermediate
Co-Chairs: Sheryl Haut, M.D., and Page B. Pennell, M.D.
Sheryl Haut, M.D.
The Valproate Controversy: The Worldwide Perspective
Torbjörn Tomson, M.D.
Pre-pregnancy Planning: AED Choice and Pregnancy Outcomes
Kimford J. Meador, M.D.
Management of Epilepsy During Pregnancy and Postpartum: AED Dosing Strategies
Page B. Pennell, M.D.
Postpartum Management: Risk of Seizures and Safety, Newborn Care and Nursing
Sanjeev Thomas, M.D.
Attendees of the 2016 Annual Meeting have free access to recordings.