Managing Epilepsy And Pregnancy – Part I

There are a staggering one and half million women in the fertile age group that are ailing with epilepsy in just India alone. Women with Epilepsy or WWE that are in the reproductive age band have been observed to have fewer offspring than other age matched controls. Neurologists and gynaecologists are frequently being faced with WWE cases during their pregnancy, a majority of who are not adeptly clued-up regarding optimal means of managing it.

Pregnancy has been known to influence the innate history of epilepsy, with seizure attacks likely to intensify in nearly a third of them. When such WWE take anti-epileptic drugs or AED course, the looming risk of significant malformation of the foetus may be increased by nearly 1.5-3 times, particularly so when the AED drug Sodium valproate in greater than 1000mg is consumed.

Numerous research carried out have revealed that seizures are controlled by the female sex hormones, namely, estrogen and progesterone. Generally, estrogen is noted to cause a lowering of the seizure threshold while conversely, progesterone is known to raise it. In a certain study conducted, wherein four out of the seven women suffering from partial epilepsy that were intravenously injected with conjugated estrogen displayed significant reduction of the seizure frequency.

Seizures are known to occur during pregnancy and after delivery due to numerous reasons, but epilepsy has been known to be the most prevalent cause for such seizures. On certain occasions other reasons for getting seizures could be due to metabolic distortion, eclampsia and cerebral venous sinus thrombosis that are classified as special syndromes. Periodic seizures that take place without any aggravating factors, come solely under the grouping of epilepsies.

In many cases, the seizures would have already commenced prior to pregnancy. In rare cases, the women would experience seizures solely during pregnancy, a condition known as gestational epilepsy. These women would be seizure-free in between pregnancies. In another sub-set of women that are grouped under gestational onset epilepsy, might experience their foremost seizure during pregnancy and subsequent to that, would continue to get unprompted frequent seizures. Nearly one to two percent of WWE during their pregnancy might experience a condition known as status epilepticus or SE that is correlated to elevated levels of morbidity and death. Pregnancy has a variable effect on the frequency of seizures that may remain unchanged or even reduce in two third of WWE, while in others it might intensify.

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