Expert Guides Women with Epilepsy through Pregnancy Challenges
face a number of joys and challenges, coupled with endless questions,
before and during pregnancy. But what about mothers-to-be who also suffer
from epilepsy? "Women with epilepsy who are considering becoming pregnant
should seek medical attention and advice beforehand," says Page Pennell,
M.D., assistant professor of neurology, Emory University School of Medicine,
and director of the Emory Epilepsy Monitoring Unit. Dr. Pennell specializes
in the treatment of epilepsy in pregnant women, the only such specialist
in the metro-Atlanta area and the most recognized one in the Southeast.
Epilepsy is a chronic medical
condition produced by temporary changes in the electrical function of
the brain, causing seizures that affect awareness, movement, or sensation.
One percent of the population has epilepsy at any given time. Doctors
say in about two-thirds of the cases, no cause can be found. Known causes
in the remaining one-third of cases include complications during their
mother's pregnancy, not enough oxygen during birth, traumatic head injuries,
meningitis, encephalitis, tumors or genetic inheritance. Mothers with
epilepsy are three times as likely as non-epileptic women to give birth
to children with epilepsy.
Epilepsy can be treated
with drugs, surgery or special diets. Of those treatments, antiepileptic
drug therapy is the most common and usually the first to be tried on
Women with epilepsy who are
considering pregnancy must weigh the option of staying on their medications
during pregnancy or coming off of them. "Patients need to talk with
their doctor about which route is best for their individual situation,"
Dr. Pennell states. "In many cases, the risk of seizures is clearly
higher than the risk of medications. Seizures during pregnancy have
been associated with miscarriages."
Although the majority of
children born to mothers with epilepsy are normal, they are at an increased
risk for developmental delays or birth defects. "Newborns of women with
epilepsy have a 4-6 percent risk of birth defects, compared to the 2-3
percent risk of the general population," Dr. Pennell says. "While the
outcomes are usually positive, a small number of babies born to epileptic
mothers have congenital heart defects, neural tube defects (spina bifida)
or cleft lip and palate."
Research has shown that some
antiepileptic medications taken during pregnancy can lead to birth defects
or otherwise may adversely affect these children. But more research
is needed to determine the respective levels of risk from taking these
Therefore, a national study
is underway to test some of the most commonly prescribed seizure control
drugs. Researchers hope to find out if these medications have a negative,
lasting impact on the developing brains of fetuses when mothers take
them while pregnant. The trial, called the Neurodevelopmental Effects
of Antiepileptic Drugs, or NEAD Study, will enroll and follow 285 women
nationwide taking one of the four most commonly prescribed anti-seizure
medications from their first trimester of pregnancy until their children
are several years old. Researchers want to determine what impact carbamazepine
(Tegretol, Tegretol-XR, Carbatrol), lamotrigine (Lamictal), phenytoin
(Dilantin) and valproate (Depakote) have on a child's ability to think
This five-year, National
Institutes of Health-funded study will enroll patients at 17 study sites
nationwide, including Emory. Already underway for two years, this trial
will look at the child's actual IQ vs. its predicted IQ based on parental
testing. It will also focus on the child's nutritional status and general
health, including milestones such as when the child begins to walk and
talk. Contributing risk factors, such as low socioeconomic status and
poor diet, will be considered. Emory University is still enrolling participants
in this trial. Women who suffer from epilepsy, are pregnant or are planning
a pregnancy can find out more information about this research study
by contacting Jean Montgomery, RN, at (404) 778-3772.
"Epilepsy can be such a disruptive
and even dangerous condition for the expectant mother and for her family,
including possibly other children who are dependent on her," Dr. Pennell
explains. "Because of these factors, in many cases, treatment must continue
even though there may be some level of risk."
According to researchers,
the key is to find better medications for mothers-to-be that lower the
risks for their children. "We hope the NEAD study and further specific
research on pregnancy and epilepsy will help us be able to treat this
population of patients more thoroughly and effectively," says Dr. Pennell.