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October 30, 2002


Emory Expert Guides Women with Epilepsy through Pregnancy Challenges

Many mothers-to-be 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 a patient.

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 drugs.

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 and learn.

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.

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