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Managing Epilepsy during Labor

By Stacey Chillemi and Blanca Vazquez

Labor and delivery are usually normal for women with epilepsy. Antiepileptic medications can be given intravenously during labor to reduce the risk of a seizure. Babies sometimes have symptoms of withdrawal from the mother’s seizure medication, but these symptoms wear off after a few months and usually do not cause long-term problems.
Women in the United States who have epilepsy give birth to approximately 20,000 newborns every year. The authors have attempted to define the rate, risks, and causes of seizures during labor and delivery, because seizures during late development and delivery may seriously affect the fetus, and because primary generalized tonic-clonic (GTC) seizures may occur during labor and delivery in 1% to 2% percent of women with epilepsy.
In one study, 89 pregnant women taking antiepileptic drugs (AEDs) for epilepsy were analyzed. Six epileptologists in the group had treated these patients. The study established data and acquired new information by telephone for 83.1% of the pregnancies and categorized the women as having primary generalized or partial epilepsy. The results showed that 78% were on monotherapy, 20% took two AEDs during pregnancy, and 2% took three AEDs during pregnancy.
Seizures during labor and delivery occurred in 4 out of 32 patients (12.5%) with primary generalized epilepsy, but in none of the 57 women with partial epilepsy. None of the 38 patients with therapeutic antiepileptic drug levels before labor and delivery had seizures, compared to 3 out of 37 (8.1%) of the subtherapeutic group. Drug levels were taken at variable times in relation to delivery, limiting their value. The levels sampled were both total and free levels; the final levels would be more helpful to determine the sufficiency of antiepileptic drug coverage.
Maintaining therapeutic antiepileptic drug levels during the last trimester may help prevent seizures during labor and delivery, especially in women with generalized epilepsy. Women with epilepsy who had subtherapeutic antiepileptic drug levels before pregnancy, and had been seizure-free, may be at risk for seizures during labor and delivery.

Meet the Expert!

Stacey Chillemi

Stacey Chillemi, an epilepsy sufferer for over 27 years, has published numerous articles and books on epilepsy, including Epilepsy: You're Not Alone and My Mommy Has Epilepsy. She is a H.O.P.E. mentor for the Epilepsy Foundation and speaks at numerous schools and organizations in order to educate others about epilepsy. In 2002, Ms. Chillemi was proud to accept the Outstanding Volunteer Award from the Epilepsy Foundation of New Jersey
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Epilepsy and Pregnancy
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