Pregnancy can bring difficult choices for
a women with epilepsy. Women with epilepsy
have an increased risk of complications during
pregnancy. Seizures during pregnancy can be
damaging to the foetus, so pregnant women
with epilepsy are encouraged to have their
seizures under control. However some anti-epileptic
drugs have been shown to increase the risk
of certain abnormalities in the developing
baby, including cleft palate and some unusual
facial features. This poses a dilemma for
women whose seizures are well controlled by
drugs that are known to pose a risk to the
foetus. Nevertheless, the overwhelming majority
of women with epilepsy will deliver a normal,
healthy baby.
Considerable advances have been made in
recent years in our understanding of how
anti-epileptic drugs affect the growth of
the baby in the womb. These are providing
new avenues of investigation into the development
of new drugs which are efficient at controlling
seizures, but carry a lower risk to the
developing foetus. However there are still
many questions unanswered about the safety
of existing drugs in pregnant women. Pregnancy
registers, to gather data on the outcome
of pregnancies in women with epilepsy, have
been established, and they are now beginning
to yield results.
In September 2002, the Epilepsy Research
Foundation ((now Epilepsy Research UK) held
a workshop in Worcester College, Oxford
to discuss these issues. The Foundation
felt a workshop was needed to provide doctors
and patients with management guidelines
that are based on a survey of all the available
evidence, and which include information
on relative risk and possible treatments
for pregnant women with epilepsy. The workshop
was attended by 22 internationally-renowned
experts in the field, from Europe, Canada
and the US, to review current evidence,
identifying areas where new studies are
needed. Twenty-one invited observers from
research units and the pharmaceutical industry
also attended.
During the two-day meeting in Oxford, the
interchange of ideas and findings by the
various participants provided a unique platform
for future work in this field. The importance
of collaboration between pregnancy registers
was emphasised, as were the potential advances
that can be made due to recent progress
in molecular and biochemical techniques
in the last decade.
The proceedings were published in Epilepsy
Research in 2003:
Barrett C, Richens A. Epilepsy and pregnancy:
report of an Epilepsy Research Foundation
workshop. Epilepsy Res. 2003;52:147-87.
