Many women with epilepsy fear having more seizures during pregnancy. Now a new study by Swedish researchers has found that most women taking AEDs do not have an increased risk of seizures while they are pregnant, and many go through pregnancy seizure-free.

Dr Torbjorn Tomson and his team, from Karolinska University Hospital in Stockholm, studied the occurrence of seizures during pregnancy in 1956 pregnancies among 1882 women, all of whom were taking one or more anti-epileptic drugs. The women were taking part in the EURAP study, an international pregnancy registry, which mainly focuses on finding the comparative risk to the foetus of the various anti-epileptic drugs.

The study, published in Neurology in February 2006, found that 58% of women receiving treatment did not have a seizure during pregnancy. Having seizures during pregnancy was associated with having focal epilepsy (seizures always starting in one area of the brain) and with being on more than one AED. In most pregnancies (63%) AED therapy was not changed.

The seizures were evenly distributed among the different trimesters of pregnancy. Having a seizure-free first trimester was a good indicator of being seizure-free throughout pregnancy: 93% of women who had no seizures in the first trimester were seizure-free during the entire pregnancy.

Two percent of pregnancies had an episode of status epilepticus (36 cases). One of these episodes was associated with a stillbirth, but no maternal deaths occurred and no miscarriages. The risks associated with status epilepticus therefore appear to be lower than previously reported.

These are reassuring findings, as they indicate that for most women on AEDs, the risk of having a seizure during pregnancy is not increased. Most women with epilepsy who are taking AEDs will maintain seizure control during pregnancy.

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