Practical NeurologyNew Guideline Published for Epilepsy Management in People Who May Become Pregnant

The new guideline offers updated recommendations for antiseizure medication use during pregnancy, emphasizing optimal seizure control and fetal development, while highlighting potential risks of congenital malformations, birth defects, and neurodevelopmental issues.

A recently published guideline in Neurology offers crucial updates for health care providers on managing epilepsy in people who may become pregnant. Developed by the American Academy of Neurology, the American Epilepsy Society, and the Society for Maternal-Fetal Medicine, the guideline provides detailed recommendations on the use of antiseizure medications to optimize both maternal and fetal health, stressing the importance of early intervention and appropriate medication choices.

Key Points:

• The guideline was collaboratively developed by AAN, AES, and SMFM, updating the 2009 guidance on epilepsy management during pregnancy.
• Emphasizes early intervention before pregnancy to recommend medications and doses optimizing seizure control and fetal development.
• Advises the use of lamotrigine, levetiracetam, and oxcarbazepine during pregnancy.
• Strongly advises against the use of valproic acid, phenobarbital, and topiramate due to their association with pregnancy and neurodevelopmental complications.
• Highlights the importance of minimizing seizure occurrences during pregnancy, especially those related to the cessation of antiseizure medications.
• Recommends daily use of folic acid before and during pregnancy to decrease the risk of neural tube defects and improve neurodevelopmental outcomes.
• States that while most children born to people with epilepsy are healthy, there is a small risk of pregnancy-related problems due to seizures and antiseizure medications.
• The guideline is based on a comprehensive literature review, ensuring evidence-based recommendations.
• Endorsed by the Child Neurology Society, adding further credibility to the guideline.

“This guideline provides recommendations regarding the effects of antiseizure medications and folic acid supplementation on malformations at birth and the development of children during pregnancy so that doctors and people with epilepsy can determine which treatments may be best for them.”
— Alison M. Pack, MD, MPH

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